Suchergebnisse

This book, written decades into the HIV epidemic, reflects critically on the idea that the socially excluded populations often focused on in HIV research are in fact difficult to access and reach. The author broadly applies the concept "hard to reach" to characterize populations that researchers find difficult to engage with. Social factors that produce marginalization and ultimately result in people choosing not to engage in research are not captured by the concept of "hard to reach". Limited attention has focused on how researchers can address the social factors that result in decisions to not engage in research. Disrupting the ways in which people are conceptualized as "hard to reach" so as to refocus on transforming social systems and personal values, beliefs and approaches is understudied. This book uses case examples based on HIV research with Indigenous youth, internally displaced women, LGBTQ communities in the Global North and Global South, and persons at the intersection of these identities, to identify successful approaches to working with marginalized and often vulnerable communities and groups. The chapters signal the need for attention to five key social factors when developing successful approaches: context and storytelling; cultural humility; critical hope; imagination and possibility; and love, intimate inquiry, and the beloved community, if nations, individuals and communities are to address the epidemic in a sustainable and impactful way

Introduction / Nadine Nakamura and Carmen H. Logie -- In search of "my true self": transmasculine gender identity processes, stigma, and mental health in Peru / Amaya Perez-Brumer, Alfonso Silva-Santisteban, Ximena Salazar, Jesse Vilela, and Sari L. Reisner -- Mental health of lesbian, gay, bisexual, and transgender people in Colombia / Karen Nieves-Lugo, Andrew Barnett, Miguel Rueda, Veronica Pinho and Maria Cecilia Zea -- Living a double life and experiencing modern sexual prejudice: the effect on Ecuadorean lesbian, gay, and bisexual workers' well-being / Donatella Di Marco, Alicia Arenas, Helge Hoel, and Lourdes Munduate -- "It's because of our culture": navigating gender norms and coping with sexual stigma among lesbian, bisexual, and queer women in Jamaica / Natania L. Marcus, Carmen H. Logie, Nicolette Jones, Nicolette Bryan, and Kandasi Levermore -- LGBT mental health in Russia / Sharon G. Horne and Lindsey White -- LGBT mental health in Mongolia: a brief history, current issues, and future directions / Julie M. Koch, Douglas Knutson, and Anaraa Nyamdorj -- Stigma toward and mental health of hijras/trans women and self-identified men who have sex with men in India / Venkatesan Chakrapani, Peter A. Newman,and Murali Shunmugam -- Being gay and lesbian in Malaysia / Hemla Singaravelu and Wai Hsien Cheah -- Whose paradise? An intersectional perspective on mental health and gender/sexual diversity in Thailand / Timo T. Ojanen, Peter A. Newman, Rattanakorn Ratanashevorn, Jan W. de Lind van Wijngaarden, and Suchon Tepjan -- Mental health needs of transgender women and gay men and other men who have sex with men across sub-saharan Africa / Carolyn Brown, Keletso Makofane, Kevin Rebe, L. Leigh Ann van der Merwe, Bhekie Sithole, Daouda Diouf, Kevin Kapila, Carrie Lyons, Tonia Poteat, Shauna Stahlman, and Stefan Baral -- Conclusion / Nadine Nakamura and Carmen H. Logi -- Author biographies -- About the editors.

BackgroundLesbian, bisexual, queer and transgender (LBQT) women living with HIV have been described as invisible and understudied. Yet, social and structural contexts of violence and discrimination exacerbate the risk of HIV infection among LBQT women. The study objective was to explore challenges in daily life and experiences of accessing HIV services among HIV‐positive LBQT women in Toronto, Canada.MethodsWe used a community‐based qualitative approach guided by an intersectional theoretical framework. We conducted two focus groups; one focus group was conducted with HIV‐positive lesbian, bisexual and queer women (n=7) and the second with HIV‐positive transgender women (n=16). Participants were recruited using purposive sampling. Focus groups were digitally recorded and transcribed verbatim. Thematic analysis was used for analyzing data to enhance understanding of factors that influence the wellbeing of HIV‐positive LBQT women.ResultsParticipant narratives revealed a trajectory of marginalization. Structural factors such as social exclusion and violence elevated the risk for HIV infection; this risk was exacerbated by inadequate HIV prevention information. Participants described multiple barriers to HIV care and support, including pervasive HIV‐related stigma, heteronormative assumptions in HIV‐positive women's services and discriminatory and incompetent treatment by health professionals. Underrepresentation of LBQT women in HIV research further contributed to marginalization and exclusion. Participants expressed a willingness to participate in HIV research that would be translated into action.ConclusionsStructural factors elevate HIV risk among LBQT women, limit access to HIV prevention and present barriers to HIV care and support. This study's conceptualization of a trajectory of marginalization enriches the discussion of structural factors implicated in the wellbeing of LBQT women and highlights the necessity of addressing LBQT women's needs in HIV prevention, care and research. Interventions that address intersecting forms of marginalization (e.g. sexual stigma, transphobia, HIV‐related stigma) in community and social norms, HIV programming and research are required to promote health equity among LBQT women.

Abstract
Background
Adverse socio-cultural factors compromise the implementation of HIV prevention strategies among displaced youth. While condoms are an affordable and effective HIV prevention strategy for youth, stigma and inequitable gender norms may constrain condom self-efficacy (i.e., knowledge, intentions, and relationship dynamics that facilitate condom negotiation) and use. Further, knowledge of contextually appropriate HIV prevention approaches are constrained by limited understanding of the socio-cultural conditions that affect condom self-efficacy and use among displaced youth. Guided by syndemics theory, we examine independent and joint effects of adverse socio-cultural factors associated with condom self-efficacy and use among displaced youth living in urban slums in Kampala, Uganda.

Methods
We conducted a community-based cross-sectional survey of displaced youth aged 16–24 years living in five slums in Kampala. We used multivariable logistic regression and multivariate linear regression to assess independent and two-way interactions among adverse socio-cultural factors (adolescent sexual and reproductive health-related stigma [A-SRH stigma], perceived HIV-related stigma, and beliefs in harmful inequitable gender norms) on condom self-efficacy and recent consistent condom use. We calculated the prevalence and co-occurrence of adverse socio-cultural factors; conducted regression analyses to create unique profiles of adverse socio-cultural factors; and then assessed joint effects of adverse socio-cultural factors on condom self-efficacy and practices.

Results
Among participants (mean age: 19.59 years; SD: 2.59; women: n = 333, men: n = 112), 62.5% were sexually active. Of these, only 53.3% reported recent consistent condom use. Overall, 42.73% of participants reported two co-occurring adverse socio-cultural factors, and 16.63% reported three co-occurring exposures. We found a joint effect of beliefs in harmful inequitable gender norms with high A-SRH stigma (β = − 0.20; p < 0.05) and high A-SRH stigma with high perceived HIV stigma (β = − 0.31; p < 0.001) on reduced condom self-efficacy. We found a multiplicative interaction between high A-SRH stigma with high perceived HIV stigma (aOR = 0.52; 95% CI 0.28, 0.96) on recent consistent condom use. Additionally, we found that condom self-efficacy (aOR = 1.01; 95% CI 1.05, 1.16) and safer sexual communication (aOR = 2.12; 95% CI 1.54, 2.91) acted as protective factors on inconsistent condom use.

Conclusions
Displaced youth living in urban slums exhibited low consistent condom use. Intersecting stigmas were associated with lower condom self-efficacy—a protective factor linked with increased consistent condom use. Findings highlight the importance of gender transformative and intersectional stigma reduction approaches to increase sexual agency and safer sex practices among Kampala's slum-dwelling displaced youth.

AbstractBackgroundAdvancing mental health among refugee and displaced adolescents and youth is critically important, as chronic psychological stress can have lifelong harmful impacts. These groups experience socio-environmental stressors that can harm mental health. Informed by a social contextual framework, this study explored the prevalence of depression among urban refugee and displaced youth in Kampala, Uganda and associations with symbolic (violence), relational (social support), and material (food and community insecurity) contexts.MethodsWe implemented a cross-sectional survey with refugee and displaced adolescent girls and young women and adolescent boys and young men aged 16–24 living in Kampala's informal settlements. We conducted peer-driven recruitment, whereby peer navigators shared study information with their networks and in turn participants were invited to recruit their peers. We conducted gender disaggregated analyses, including stepwise multiple regression to examine factors associated with depression. We then conducted structural equation modeling (SEM) using weighted least squares estimation to examine direct paths from violence, food insecurity, and community insecurity to depression, and indirect effects through social support.ResultsAmong participants (n = 445), young women (n = 333) reported significantly higher depression symptoms than young men (n = 112), including any symptoms (73.9% vs. 49.1%,p < 0.0001), mild to moderate symptoms (60.4% vs. 45.5%,p = 0.008), and severe symptoms (13.5% vs 3.6%,p = 0.002). SEM results among young women indicate that the latent violence factor (lifetime sexual and physical violence) had direct effects on depression and social support, but social support did not mediate the path from violence to depression. The model fit the data well: χ2(3) = 9.82,p = 0.020; RMSEA = 0.08, 90% CI [0.03, 0.14], CFI = 0.96). Among young men, SEM findings indicate that food insecurity had direct effects on social support, and an indirect effect on depression through the mediating role of social support. Fit indices suggest good model fit: χ2(3) = 2.09,p = 0.352; RMSEA = 0.02, 90% CI [0.000, 0.19], CFI = 0.99.ConclusionsFindings reveal widespread depression among urban refugee and displaced youth in Kampala, disproportionately impacting young women. Contextual factors, including food insecurity and violence, increase depression risks. Strategies that reduce gender-based violence and food insecurity, and increase social support networks, have the potential to promote mental health among urban refugee and displaced youth.

Abstract
Party-n-Play (PNP) refers to sex between gay and bisexual men that occurs under the influence of drugs. Growing evidence suggests gay and bisexual men who PNP experience significant stigma and social exclusion. Less is known about the resilience of this population. Utilising critical discourse analysis, this study examined how gay and bisexual men who PNP talk about social exclusion and resilience in their lives. In-depth one-hour interviews were conducted with forty-four gay and bisexual men who lived in Toronto, and who used various drugs before or during sex with another man in the previous month. Study findings revealed that social exclusion was perpetuated through discourses of stigma, deviance, morality, heteronormativity, homophobia, racism, classism, risk and policing. These discourses also negatively affected participants' interactions with health care providers. However, many participants evoked resilience discourses and described social bonds, friendships and relations of care in their networks. Social work professionals would benefit from examining the roles of social exclusion, as well as stigmatising and pathologising discourses in their practice. These findings also underscore the need for culturally sensitive social work interventions for this population that address social exclusion and foster resilience.

The Government of Nigeria passed the Same-Sex Marriage Prohibition Act (SSMPA) in 2014, emboldening the human rights violations of LGBT Nigerians by state and nonstate actors. Nigerian police enforce morality laws that criminalize same-sex relations, but their role as perpetrators of violence has not been well studied. Using six-year (2014 to 2019) administrative data, this article investigates the severity, prevalence, and typology of police violence and abuse of LGBT Nigerians. Since SSMPA, violence against LGBT Nigerians has risen by 214 percent. Survivors frequently report arbitrary arrest and unlawful detention, invasion of privacy, physical assault and battery, and blackmail/extortion. This study is the first to present serial, cross-sectional findings of LGBT Nigerians' experience with the police. Available administrative reports and data were synthesized to produce a general picture of the situation on the ground. Findings point to actionable social and policy recommendations that can be taken to promote police accountability and improve police-LGBT community relations.