scholarly journals Structural vulnerabilities and healthcare services integration

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Bent Steenberg
Keyword(s):  
Life Histories ◽  
Significant Proportion ◽  
Healthcare Services ◽  
Medical Pluralism ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Structural Factors ◽  
Migrant Communities ◽  
Collective Narratives ◽  
Cultural Estrangement

Home to one fifth of all people living with HIV, South Africa carries the world’s heaviest burden of this disease. While a significant proportion of those infected are immigrants from other African high-prevalence countries, little is known about how these migrants engage with healthcare systems in shifting cultural and clinical settings. This article draws on fieldwork from migrant communities and twenty-one ethnographic life histories told by HIV-positive Mozambicans in a major South African HIV clinic. From their collective narratives, a range of structural vulnerabilities are found that limit immigrants’ access to, and proper integration within, healthcare services. These include perilous migration, xenophobia and deportation, exclusion and exploitation, language barriers, medical pluralism, cultural estrangement, social isolation, and the stigmas of being HIV-positive. In conjunction, these structural factors may delay treatment-seeking and inhibit drug adherence, which could increase rates of morbidity and mortality as well as contribute to viral mutation and antiretroviral drug resistance.

scholarly journals Lived experiences of people living with HIV: a descriptive qualitative analysis of their perceptions of themselves, their social spheres, healthcare professionals and the challenges they face daily

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gamze Senyurek ◽  
Mustafa Volkan Kavas ◽  
Yesim Isil Ulman
Keyword(s):  
Lived Experiences ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Partner Notification ◽  
Healthcare Setting ◽  
Healthcare Services ◽  
People Living With Hiv ◽  
Structural Factors ◽  
Hiv Diagnosis ◽  
Living With Hiv

Abstract Background Human immunodeficiency virus (HIV) infection rates have been gradually increasing in Istanbul, Turkey. Many people living with HIV (PLWH) here encounter difficulties, for example, in adapting to the chronic disease and obtaining continuous access to healthcare services. In this study, we aimed to explore the challenges PLWH face in their daily lives and understand their perceptions of themselves, healthcare professionals and services, and their social spheres via their expressed lived experiences in the healthcare setting. Method Individual semi-structured in-depth interviews were conducted face-to-face with 20 PLWH in Istanbul. All the interviews were voice-recorded and transcribed verbatim except one, upon participant request, for which the interviewer took notes. These logs and the interviewer’s notes were analyzed thematically using the inductive content analysis method. Results The themes concerned experiences in three distinct contexts: 1) Interactions with healthcare providers; 2) Participants’ responses to their HIV diagnosis; and 3) Interactions with their social networks. Firstly, the results highlighted that the participants perceived that healthcare professionals did not inform them about the diagnosis properly, failed to protect patients’ confidentiality and exhibited discriminative behaviors towards them. Secondly, after the diagnosis the participants had difficulty in coping with their unsettled emotional state. While many ceased sexual activities and isolated themselves, some sought support. Lastly, living with HIV affected their relationships with their families and friends either positively or negatively. Moreover, they had to face the difficulties concerning spouse/partner notification issues about which many needed professional support. Conclusion Healthcare professionals’ discriminative or inappropriate attitudes and customs in healthcare institutions are perceived to impair PLWH’s utilization of healthcare services. Structural factors such as social pressure, societal ignorance about HIV, limited access to HIV prevention, and regulatory barriers might contribute to these challenges. The results suggest that it is necessary to raise healthcare professionals’ and society’s awareness about HIV and develop national policies to establish a well-functioning referral system and appropriate spouse/partner notification services.

scholarly journals Stigmatization, discrimination, violation of autonomy, and compromised confidentiality: A descriptive qualitative analysis of the lived experiences of people living with HIV in healthcare settings in Turkey

2021 ◽  
Author(s):  
Gamze Senyurek ◽  
Mustafa Volkan Kavas ◽  
Yesim Isil Ulman
Keyword(s):  
Lived Experiences ◽  
Healthcare Professionals ◽  
Partner Notification ◽  
Healthcare Setting ◽  
Healthcare Services ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Structural Factors ◽  
Failure To Protect ◽  
Living With Hiv

Abstract Background: Human immunodeficiency virus (HIV) infection rates have been gradually increasing in Istanbul, Turkey. Many people living with HIV (PLWH) in Turkey encounter difficulties such as adapting to a chronic disease and maintaining continuous access to healthcare services. In this study, we explored the challenges PLWH face in their daily lives and understand their perceptions of themselves, healthcare professionals, their social spheres, and healthcare services via their expressed lived experiences in the healthcare setting.Method: Individual semi-structured in-depth interviews were conducted face-to-face with 20 people living with HIV in Istanbul. All the interviews were voice-recorded and transcribed verbatim except one, upon participant request, for which the interviewer took notes. These logs and the interviewer’s filed notes were analyzed thematically using the inductive content analysis method. Thematic pattern tables showing the relations of relevant contexts, main themes, sub-themes, and codes were then formed. Results: The results highlighted the following themes: problems with patients’ autonomy, failure to protect patients’ confidentiality and privacy of personal health data, spouse/partner notification issues, the negative effect of living with HIV on their perception of themselves, stigmatizing and discriminatory attitudes intrinsic in healthcare professionals’ approaches, and their struggle to deal with such approaches. Our participants’ experiences suggest that PLWH may face multi-dimensional challenges that directly and negatively affect their lives, identities, relationships, and social status in Turkey. Conclusion: This study showed the complex and shifting nature of stigma experiences. Healthcare professionals’ discriminative or inappropriate attitudes and customs prevailing in healthcare institutions impair PLWH’s utilization of healthcare services. Additionally, structural factors such as social pressure, societal ignorance about HIV, limited access to HIV prevention, and present barriers to HIV care and support originating from current regulations contribute to these challenges. Based on these results, we argue that it is necessary to raise healthcare professionals’ and society’s knowledge and awareness concerning HIV, to train qualified community service personnel providing assistance, care, support, and education to patients, to establish a well-functioning referral system, and to develop national policies to establish appropriate partner notification services. We believe that such interventions should begin to address the social, economic, and structural factors that drive stigma.

Trends in the location of the HIV-positive population in Australia: Implications for access to healthcare services and delivery

Sexual Health ◽  
2010 ◽  
Vol 7 (2) ◽  
pp. 154 ◽  
Author(s):  
Marina Carman ◽  
Jeffrey Grierson ◽  
Marian Pitts ◽  
Michael Hurley ◽  
Jennifer Power
Keyword(s):  
Healthcare Service ◽  
Service Use ◽  
Healthcare Services ◽  
Capital City ◽  
Service Development ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Service Access ◽  
Longitudinal Data Collection ◽  
Positive Population

Background: Examining existing and potential trends in the HIV-positive population in Australia is important for current and future healthcare service development and delivery. Methods: A new analysis of existing data on this population from the HIV Futures 5 survey was based on linking a geographic breakdown of respondents based on ‘area type’ – capital city or inner suburban, outer suburban, regional centre and rural – with patterns of healthcare service access. In addition, the distance between the postcode of the respondent’s residence and the postcode of the doctor seen for HIV-related treatment was calculated. An analysis of ‘area type’ by income and age was also conducted. Results: The ‘area type’ analysis showed important differences in patterns of access to antiretroviral prescriptions and choice of provider for HIV-related and general healthcare. The median distance travelled to see a doctor for HIV-related treatment was higher for those living in outer suburbs than those living in regional centres. Discussion: Differences in service use appear to be related to geographic accessibility of different service types. However, there may be other important social, economic and cultural factors involved. Ageing and socio-economic pressures may be influencing a move away from inner suburban areas where most HIV-specific care is located. This new analysis assists in finding the right balance between increasing the accessibility of HIV-specific services and ‘mainstreaming’. Longitudinal data collection would further assist in tracking trends in geographic location, and how often and at what intervals people living with HIV utilise healthcare services.

Ageing with HIV/AIDS: a scoping study among people aged 50 and over living in Quebec

2012 ◽  
Vol 33 (7) ◽  
pp. 1212-1242 ◽  
Author(s):  
ISABELLE WALLACH ◽  
SHARI BROTMAN
Keyword(s):  
Lived Experience ◽  
Significant Proportion ◽  
Intergenerational Relationships ◽  
Phenomenological Approach ◽  
People Living With Hiv ◽  
Structural Factors ◽  
Individual Interviews ◽  
Relational Work ◽  
Living With Hiv ◽  
The Impact

ABSTRACTThe population of people aged 50 and over represents a significant proportion of people living with HIV in Western nations. While the number of older people living with HIV is rapidly increasing in Canada, research originating in this country remains relatively scarce. This article therefore proposes to describe the impact of the intersection of HIV and ageing on the identities and lived experiences of people living with HIV of 50 and over (PLHIV50+), both on an individual and social level, in order to offer a picture of their lived experience. Using a phenomenological approach, nine semi-structured individual interviews with PLHIV50+ (men and women) were undertaken. Data analysis identified several central themes which constituted the essence of their experience of the intersection of HIV and ageing, such as the experience of premature ageing, the impact of HIV on intergenerational relationships, the shrinking of one's social network, rejection experienced by the older population, a difficult return to work and a deterioration in living conditions. The results of this research highlight the many challenges faced by PLHIV50+, on physical, relational, work and economic levels. Even though some of the problems faced by PLHIV50+ were related to the experience of corporal changes and a deterioration of health, our research was able to highlight the societal and structural factors underlying the stigma of HIV and ageing.

Professional dilemmas for caregivers in Turkish home care settings in Germany

2014 ◽  
Vol 1 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Jan Basche
Keyword(s):  
Healthcare Services ◽  
Insurance Companies ◽  
Or Education ◽  
Migrant Communities ◽  
Caregiver Relationship ◽  
International Nursing ◽  
Nursing Literature ◽  
Intercultural Care ◽  
The Given

While calling for culturally sensitive healthcare services in migrant communities, the international nursing literature on intercultural care predominantly describes nursing staff as lacking cultural competences and immigrant customers as lacking cleverness to navigate the labyrinths of national healthcare systems. Congruences in language, culture and religion in the customer-caregiver relationship can decisively improve the quality of care. However, they do not automatically guarantee smooth working processes in monocultural in-home settings. On the contrary, new problems occur here for Turkish caregivers which are unknown to the legions of native professionals who feel challenged by migrants and which go beyond differences such as age, sex, income or education. While no cultural or religious brokering is necessary between customers and personnel in the given context in Germany, new challenges arise when caregivers are expected to legally broker between customers and insurance companies or doctors. Conflicting expectations of customers and management as well as their own colliding social and professional roles put the caregivers in a quandary and must be competently managed.

The Bio/Necropolitics of ACTG 076: Lessons from Pregnant Women of Colour Living with HIV for Treatment for Prevention in the Twenty-first Century

Somatechnics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 233-253
Author(s):  
Eli Manning
Keyword(s):  
Hiv Transmission ◽  
Ethical Dilemmas ◽  
Hiv Treatment ◽  
First Century ◽  
Hiv Positive ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Hiv Positive Women ◽  
Aids Clinical Trials ◽  
Living With Hiv

Since the pharmaceutical turn, using HIV treatment to prevent transmission is increasingly common. Treatment as Prevention®, or TasP, has relied on HIV treatment to prevent HIV transmission, targeting people living with HIV. However, TasP is predicated on troublesome heterosexist, classist, and racist medical practices borrowed from various times and spaces that enact biopolitical and necropolitical relations. This paper discusses the debate surrounding the first clinical trial that used HIV treatment to prevent transmission from woman-to-foetus. The 1994 landmark AIDS Clinical Trials Group 076 study laid the groundwork for using HIV treatment to prevent HIV transmission, the essential precursor to TasP. By examining the concerns of HIV positive women of colour and other AIDS activists, we are able to understand the ethical dilemmas and practical consequences that still haunt today's game-changing uses of HIV treatment for prevention and to see how biopolitics and necropolitics persist in TasP.

Dental Disease Nonbattle Injury Rates of Deployed NATO Militaries in the Middle East Region: A Scoping Review

2020 ◽  
Author(s):  
Matthew Vaughan ◽  
Troy McGowan ◽  
Greg Mahoney
Keyword(s):  
Scoping Review ◽  
Dental Treatment ◽  
Significant Proportion ◽  
Healthcare Services ◽  
Dental Disease ◽  
Operational Effectiveness ◽  
Dental Services ◽  
Injury Rates ◽  
East Region ◽  
Middle East Region

ABSTRACT Introduction The occurrence of dental emergencies, now termed as dental disease nonbattle injuries (D-DNBIs), has long been an impacting factor on militaries’ operational effectiveness. Owing to D-DNBIs contributing to low morale, the removal of personnel from duty, causing logistical hardships, and requiring deployable dental teams to operate in theater, there remains a significant benefit in the reduction in the occurrence of D-DNBIs. No study to date has reviewed D-DNBI rates specific to a modern military, and insight into whether militaries are seeing improvements in their dental preparedness remains to be gained. Materials and Methods A scoping review was conducted in accordance with the guidelines set out by Joanna Briggs Institute. Databases searched included SCOPUS, PubMed, OVID, and DOSS. Six hundred and one articles were initially screened, and six articles were included in the final review. Results A D-DNBI rate of 172 per 1,000 members per year was reported across the coalition, with the U.S., UK, and French militaries reporting on their dental experience. Both the French data and one UK study reported significantly higher D-DNBIs than their U.S. counterparts, who described 124 D-DNBIs per 1,000 members per year. A significant proportion of these D-DNBIs were reported to be “preventable,” which raises questions on the efficacy of garrison healthcare services. Dental disease nonbattle injury rates appear to be largely consistent with what was first reported decades ago, and there remains ongoing and significant value in expeditionary dental services providing supportive healthcare for any deployed military personnel. Conclusion Rates of D-DNBIs appear to be stable with what was historically reported when an international coalition is considered, with national variation. There remains a significant number of D- DNBIs which require dental treatment within the operational theater, and further efficiencies can be gained from predeployment treatment of “preventable” D-DNBIs.

scholarly journals Assessment of Health-Related Quality of Life among People Living with HIV in Xinjiang, West China

2017 ◽  
Vol 16 (6) ◽  
pp. 588-594 ◽  
Author(s):  
Rena Maimaiti ◽  
Zhang Yuexin ◽  
Pan Kejun ◽  
Maimaitaili Wubili ◽  
Christophe Lalanne ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Southern China ◽  
Health Concern ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Health Related Quality ◽  
Patient Reported ◽  
Related Quality ◽  
Health Related

In total, 679 HIV-positive patients from 4 clinics in Urumqi city were given structured questionnaires by the doctors or nurses treating them. Health-related quality of life (HRQL) was assessed using the Chinese Patient-Reported Outcome Quality of Life-HIV questionnaire versions in Mandarin and Uyghur. This tool has been used in other parts of China and several countries. Compared to France, Australia, United States, Brazil, Thailand, Cambodia, Senegal, and Central-Southern China (CS China), the HRQL was significantly lower among HIV-positive patients in Xinjiang, with regard to the dimension of treatment impact and general health score. The health concern was similar to Brazil and Cambodia but lower than other countries and CS China. Our findings showed high stigmatization: 86% of the patients were afraid to tell others they were HIV positive and 69% often felt or always felt depressed. Only 1% of the patients were on antidepressant treatment.

scholarly journals Food consumption and nutritional status of people living with HIV/AIDS (PLWHA): a case of Thika and Bungoma Districts, Kenya

2009 ◽  
Vol 13 (4) ◽  
pp. 475-479 ◽  
Author(s):  
Elizabeth Nafula Kuria
Keyword(s):  
Nutritional Status ◽  
Food Consumption ◽  
Dietary Habits ◽  
Well Being ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Significant Difference ◽  
Living With Hiv ◽  
Hiv Aids

AbstractObjectiveTo establish the food consumption, dietary habits and nutritional status of people living with HIV/AIDS (PLWHA) and adults whose HIV status is not established.DesignCross-sectional descriptive survey.SettingThika and Bungoma Districts, Kenya.SubjectsA random sample of 439 adults; 174 adults living with HIV/AIDS and 265 adults whose HIV/AIDS status was not established in Thika and Bungoma Districts.ResultsMajority of PLWHA consume foods that are low in nutrients to build up the immune system and help maintain adequate weight, and there is little variety in the foods they consume. More adults who are HIV-positive are undernourished than those whose status is not established. Of the HIV-positive adults, those with a BMI of ≤18·5 kg/m2 were 23·6 % (Thika 20·0 % and Bungoma 25·7 %) while of the adults whose status is not established those with BMI ≤ 18·5 kg/m2 were 13·9 % (Thika 9·3 % and Bungoma 16·7 %).ConclusionsAdults who are HIV-positive are more likely to be undernourished than those whose status is not established, as there is a significant difference (P = 0·000) between the nutritional status (BMI) of PLWHA and those whose HIV/AIDS status is not established. PLWHA consume foods that are low in nutrients to promote their nutritional well-being and health.

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