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Grammatikopoulou MG, Gkiouras K, Pepa A, Persynaki A, Taousani E, Milapidou M, Smyrnakis E, Goulis DG. Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action. Maturitas 2021; 154:31-45. [PMID: 34736578 DOI: 10.1016/j.maturitas.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.
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Affiliation(s)
- Maria G Grammatikopoulou
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, Alexander Campus, International Hellenic University, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aleks Pepa
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Greece
| | | | - Eleftheria Taousani
- Department of Midwifery, Faculty of Health Sciences, International Hellenic University, Alexander Campus, Thessaloniki, Greece
| | - Maria Milapidou
- Dr. Juris, Post Doc Researcher, Faculty of Law, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Noor MN, Holt M, Qureshi A, de Wit J, Bryant J. Sexual risk-taking among homeless young people in Pakistan. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1550-1558. [PMID: 33170554 DOI: 10.1111/hsc.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/24/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Abstract
Homeless young people who engage in sex work are at increased risk of HIV and other sexually transmitted infections like chlamydia, gonorrhoea, syphilis and herpes. Semi-structured interviews were conducted with 29 homeless young people between the ages of 16 and 25 years from Rawalpindi, Pakistan, to explore how sexual practices were mediated through social and contextual conditions. Participants engaged in sex for a range of reported reasons, most commonly to generate income, but also to build intimacy and to establish intimate partnerships which could bring physical protection and social and emotional support. Although participants were aware of the sexual health risks attached to condomless sex, they engaged in it due to the social obligations of intimate partnerships, financial considerations and to better manage potentially violent situations. Instead of condoms, participants used alternate methods like withdrawal, oral sex, post-sex douching and specific sexual positions. These were not always useful, and some methods might have inadvertently increased their risk of HIV. The study findings suggest that an integrated health promotion approach that goes beyond the health sector and a singular emphasis on risk awareness may help reduce young people's risk of homelessness and sexual health risks.
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Affiliation(s)
- Muhammad N Noor
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - Ayaz Qureshi
- Department of Social Anthropology, The University of Edinburgh, Edinburgh, United Kingdom
| | - John de Wit
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
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Marks LR, Stenersen M, Coleman M, Sanders S, Wilkins-Yel K. Health psychology in Jamaica: A qualitative analysis. COUNSELLING PSYCHOLOGY QUARTERLY 2021. [DOI: 10.1080/09515070.2021.1927670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Laura Reid Marks
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, FL, USA
| | - Madeline Stenersen
- Division of Prevention and Community Research, Yale University School of Medicine, New Haven, CT, USA
| | - Monica Coleman
- Department of Counseling Educational Psychology and Research, University of Memphis, Memphis, TN, USA
| | - Shondolyn Sanders
- Department of Counseling Educational Psychology and Research, University of Memphis, Memphis, TN, USA
| | - Kerrie Wilkins-Yel
- Department of Counseling & School Psychology, University of Massachusetts-Boston, Boston, MA, USA
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Figueroa JP, Duncan JP, Bailey A, Skyers N. The HIV epidemic in Jamaica: a need to strengthen the National HIV Program. Rev Panam Salud Publica 2020; 44:e157. [PMID: 33245295 PMCID: PMC7679044 DOI: 10.26633/rpsp.2020.157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To assess the status of the HIV epidemic and programmatic implementation in Jamaica while identifying strategies for achieving effective HIV control. Methods The assessment included a review of the core indicators of the UNAIDS Global Monitoring Framework, a desk review of program reports, and unstructured interviews of stakeholders. Results HIV prevalence among adults in Jamaica was 1.5% in 2018 with an estimated 32 617 persons living with HIV (PLHIV) and 27 324 persons (83.8%) diagnosed with HIV; 12 711 (39.0% of all PLHIV or 46.5% aware of their status) were on anti-retroviral therapy (ART) in the public health sector and 61.8% PLHIV on ART were virally suppressed. HIV prevalence among men who have sex with men remains high (31.4% in 2011, 29.6% in 2017) but has declined among female sex workers (12% in 1990, 2% in 2017). HIV prevalence among public sexually transmitted infection clinic attendees, prison inmates and the homeless has increased in recent years. During 2018 approximately 200 000 persons (14% of the population 15-49 years) were tested with 1 165 newly diagnosed PLHIV, indicating that many of the estimated 1 600 newly infected persons in 2018 were unaware of their status. Conclusions Critical policy initiatives are needed to reduce barriers to HIV services, ensure young persons have access to condoms and contraceptives, affirm the rights of the marginalized, reduce stigma and discrimination, and introduce pre-exposure prophylaxis. While HIV spread in Jamaica has slowed, the UNAIDS Fast Track goals are lagging. The HIV program must be strengthened to effectively control the epidemic.
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Affiliation(s)
- J Peter Figueroa
- The University of the West Indies, Mona Kingston Jamaica The University of the West Indies, Mona, Kingston, Jamaica
| | - Jacqueline P Duncan
- The University of the West Indies, Mona Kingston Jamaica The University of the West Indies, Mona, Kingston, Jamaica
| | - Althea Bailey
- The University of the West Indies, Mona Kingston Jamaica The University of the West Indies, Mona, Kingston, Jamaica
| | - Nicola Skyers
- Ministry of Health and Wellness Kingston Jamaica Ministry of Health and Wellness, Kingston, Jamaica
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Beckford Jarrett S, Flanagan R, Coriolan A, Harris O, Campbell A, Skyers N. Barriers and facilitators to participation of men who have sex with men and transgender women in HIV research in Jamaica. CULTURE, HEALTH & SEXUALITY 2020; 22:887-903. [PMID: 31423952 DOI: 10.1080/13691058.2019.1634222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
To assess potential barriers and facilitators to participation in bio-behavioural surveillance surveys of men who have sex with men and transgender women (trans women) in Jamaica, we recruited participants for individual interviews and focus group discussions. Respondents included 3 trans women; 46 gay, bisexual and other men who have sex with men; and 3 cis gender women. Data from 46 men and 3 trans women were analysed to describe barriers and facilitators to participation in research. Barriers identified were: lack of perceived benefits from research participation due to high socioeconomic status; concerns about confidentiality and unintended disclosure; HIV fatigue and fear of knowing one's HIV status; distrustful inter-group dynamics; and undesirable study location and hours. Facilitators to participation in research were: belonging to a marginalised subgroup of men who have sex with men or trans women; incentives; and trust in researchers and community input in planning the study. Findings emphasise the need to understand the individual, interpersonal and structural factors that shape relationships, disclosure and interactions to successfully enrol diverse samples of men who have sex with men and trans women.
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Affiliation(s)
| | | | | | - Orlando Harris
- School of Nursing, University of California, San Francisco, CA, USA
| | - Andrea Campbell
- Jamaica National Family Board - Sexual Health Agency, Kingston, Jamaica
| | - Nicola Skyers
- HIV/STI/Tb Unit, Ministry of Health, Kingston, Jamaica
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Brickley DB, Lindan CP. AIDS Prevention Research: Training and Mentoring the Next Generation of Investigators from Low- and Middle-Income Countries. AIDS Behav 2018; 22:1-3. [PMID: 29916190 DOI: 10.1007/s10461-018-2189-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Deborah B Brickley
- Institute for Global Health Sciences, University of California, San Francisco, USA.
| | - Christina P Lindan
- Institute for Global Health Sciences, University of California, San Francisco, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
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