Struggling to care: A discursive-material analysis of negotiating agency among HIV-positive MSM

"Self-care is being attentive to yourself": using assemblages to examine discursive-material practices of self-care among Filipino university students

PURPOSE

Researchers have observed a rise in mental health issues among university students over the course of the pandemic, in part due to the closure of schools and public spaces for wellness. Thus, the purpose of this study is to explore how students creatively reassemble their self-care practices through different objects and spaces within their homes to care for their mental health.

METHODS

Photo-elicitation interviews were conducted with ten (10) female university students from the Philippines. Photographs and interview transcripts were analysed through map-making practices and an iterative process of crafting assemblages and their cofunctionings.

RESULTS

The work-home assemblage was identified as the site of self-care, delineated by boundary-making and place-making practices and the creation of time spaces. The two major cofunctionings of the work-home assemblage were (a) caring for the self as fostering different relationalities with the self, and (b) caring for the self as copresencing with human and nonhuman others.

CONCLUSION

Findings demonstrate the importance of material and spatial relationalities in facilitating caring relational encounters with the self. Theoretical and practical implications include attuning to the existing material and spatial resources in one's environment and integrating them into one's practices of caring for the self.

Responsibility in Medical Sociology: A Second, Reflexive Look

Personal responsibility has emerged as an important element in many countries' public health planning, and has attracted substantial debate in public health discourse. Contemporary medical sociology typically resists such "responsibilization" as victim-blaming, by privileged elites, that obscures important structural factors and inequities. This paper, based primarily on a broad review of how contemporary Anglophone medical sociology literatures treat responsibility and blame, points out advantages of taking responsibility seriously, particularly from the individual's perspective. These advantages include: empowerment; responsibility-as-coping-mechanism; moral dignity; and the pragmatic logic of doing for oneself, rather than passively awaiting societal reforms. We also offer possible reasons why sociologists and their subjects view these issues so differently, and suggest some areas for future research.

Engagement in Care Among Newly Diagnosed HIV-Positive Gay, Bisexual, and Other Men Who Have Sex With Men in the United States: Results From the Together 5,000 Study

One-quarter of gay, bisexual, and other men who have sex with men (GBMSM) with diagnosed HIV are not engaged in HIV care. Between 2018 and 2019, 50 GBMSM completed qualitative interviews 3 months after receiving an HIV-positive result. Interviews explored barriers to and facilitators of engagement and retention in HIV testing and care. Thematic analysis revealed five major themes: (1) reason for HIV testing (e.g., self-testing), (2) linkage to care (e.g., appointment/logistic issues and social support as encouragement), (3) barriers to engagement in care (e.g., financial burden, competing priorities, and fear/stigma), (4) facilitators of engagement (e.g., financial assistance, patient-provider relationships, auxiliary support services, and health agency), and (5) PrEP as a missed prevention opportunity. Addressing individual-, social-, and policy-level barriers could improve GBMSM's engagement in HIV care. Further, capitalizing on GBMSM's health agency through partnerships with local agencies and fostering better patient-provider relationships could optimize HIV care continuity.

Bodies-in-waiting as infrastructure: Assembling the Philippine Government's disciplinary quarantine response to COVID-19

The purpose of this article is to advance the concept of bodies-in-waiting as an everyday infrastructure to explain the shifting nature of ‘pandemic cities’ in response to the changing dynamics of infection control in urban spaces. While previous literatures have been ‘sanitized’ to emphasize the importance of managing optimal physiological health and safety, we would like to argue that keener attention is needed to rethink the constitutive role of bodies in co-producing a city's sociopolitical ecologies at this time of crisis. The main body is divided into three sections. The first section introduces the political dimensions of pandemic response by various governments with an emphasis to experiences of middle to low income countries. Our intention is to show how these studies bring into light the role of local politics of pandemic response within countries, and that actual governance mechanisms in cities are shaped and contested by shifting power blocs and emergent affinities. The second section forwards an embodied urban political approach that conceptualizes bodies-in-waiting as infrastructure. In this view, bodies-in-waiting is produced and reproduced by complex social-material flows and transformation rooted in variegated matrices of power through which urban spaces are (re)assembled. The last section demonstrates a sample case that shows how bodies-in-waiting as infrastructure are understood using Twitter-sourced data associated with the Philippine government's disciplinary quarantine measures which started March 12, 2020 in the NCR. At its core, bodies-in-waiting as infrastructures populate a politically affirmative urban imaginary of bodies living on despite the existence of an accelerated and mutating virus in slower moving cities.

Culture-embedded drivers and barriers to (non) condom use among Filipino MSM: a critical realist inquiry

This qualitative study examines the drivers and barriers of condom use among Filipino men who have sex with men (MSM) using a critical realist inquiry (i.e., shared meanings, norms, and practices related to condom use). Thematic analysis was used to analyze interviews of 105 MSM participants across 21 cities in the Philippines. Key findings showed three social structures that shape how participants view sexual partners as safe (linked to non-condom use) or unsafe (linked to condom use). First, classism is linked to relative economic social position of sexual partner (lower socio-economic class as unsafe; higher socio-economic class as safe). Second, heteronormativity is linked to relationship arrangements (multiple partner as unsafe; exclusive partner as safe) and identity categories (bisexuals as unsafe; straight men are safe). Third, body-ism is linked with notions of health (looks sick as unsafe; looks healthy as safe) and appearance (not good looking as unsafe). Sexual partners perceived as good looking can be construed as either safe or unsafe. Discussion points highlight importance of understanding the cultural and material contexts of looking and sounding educated, looking healthy, looking physically attractive vis-à-vis promoting condom use.

Development of a Mobile Game to Influence Behavior Determinants of HIV Service Uptake Among Key Populations in the Philippines: User-Centered Design Process

Background

Opportunities in digital distribution place mobile games as a promising platform for games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. Although user-centered design is widely advocated, factors such as the user’s subject domain expertise, budget constraints, and poor data collection methods can restrict the benefits of user involvement.

Objective

This study aimed to develop a playable and acceptable game for health, targeted at young key populations in the Philippines.

Methods

Authors identified a range of user-centered design methods to be used in tandem from published literature. The resulting design process involved a phased approach, with 40 primary and secondary users engaged during the initial ideation and prototype testing stages. Selected methods included participatory design workshops, playtests, playability heuristics, and focus group discussions. Subject domain experts were allocated roles in the development team. Data were analyzed using a framework approach. Conceptual frameworks in health intervention acceptability and game design guided the analysis. In-game events were captured through the Unity Analytics service to monitor uptake and game use over a 12-month period.

Results

Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to this type of game was restricted because of technical and economic constraints. A role-playing game (RPG) with combat elements was identified as a very appealing gameplay style. Findings guided us to a game that could be played offline and that blended RPG elements, such as narrative and turn-based combat, with match-3 puzzles. Although the game received a positive response during playtests, gameplay was at times perceived as repetitive and predicted to only appeal to casual gamers. Knowledge transfer was predominantly achieved through interpretation of the game’s narrative, highlighting this as an important design element. Uptake of the game was positive; between December 1, 2017, and December 1, 2018, 3325 unique device installs were reported globally. Game metrics provided evidence of adoption by young key populations in the Philippines. Game uptake and use were substantially higher in regions where direct engagement with target users took place.

Conclusions

User-centered design activities supported the identification of important contextual requirements. Multiple data collection methods enabled triangulation of findings to mediate the inherent biases of the different techniques. Game acceptance is dependent on the ability of the development team to implement design solutions that address the needs and desires of target users. If target users are expected to develop design solutions, they must have adequate expertise and a significant role within the development team. Facilitating meaningful partnerships between health professionals, the games industry, and end users will support the games for health industry as it matures.

Putting the "where" in HIV care: Unpacking narratives of antiretroviral therapy adherence among HIV-Positive men who have sex with men

This study explores the spatial constitution of adherence to antiretroviral therapy (ART) by recasting therapeutic landscapes (Gesler, 1992) and how it structures the exercise of expressive agency (Bowden, 2014). Engagement in antiretroviral therapy among HIV-positive men who have sex with men (MSM) is contextualized within the discursive-materiality of emplaced assemblages for HIV Care in the Philippines. Combining qualitative data from field visits and semi-structured interviews, three key spatial narratives were derived illustrating how adherence to ART unfolds in place: (a) an unwelcoming treatment hub, (b) an unsafe and safe home, and (c) a constraining workplace. The results illustrate the spatial, multilayered barriers to ART adherence proposing insights for the theorization of adherence as an emplaced process and the implications of using of place-based interventions in resource-limited countries beyond the discourse of free service and availability.

Falling into poverty: the intersectionality of meanings of HIV among overseas Filipino workers and their families

Many years of labour migration have opened opportunities as well as exposed overseas Filipino workers to health vulnerabilities. In the light of the increasing number of HIV cases in the country, these workers may be conceived as an at-risk group in need of careful attention. This study, which focuses on the experiences of HIV-positive overseas Filipino workers, describes the meanings HIV carries, together with implications for workers' identities as they return home to their families. Recognising that HIV may affect different groups in different ways, we analysed 13 accounts from heterosexual men and women and gay men from the lens of intersectionality. We found three major storylines, namely: the 'fallen hero' and the struggle of losing the body for heterosexual men; 'children in poverty' and the struggle of losing the mind for heterosexual women; and the 'crushed dream' and the struggle of losing dignity for gay men. Surviving with HIV and poverty in the context of continuing heteronormative familial duties suggests the need for family-centered interventions for HIV-positive overseas Filipino workers.