Suchergebnisse

There is a clear need for effective strategies to address the factors that affect retention, or Lost-to-follow-up (LTFU) and adherence to HIV care and treatment. Depression in particular may play an important role in the high rates of LTFU along the prevention of mother-to-child HIV transmission (PMTCT) cascade in sub-Saharan Africa. This study assessed the association between prenatal depression and 1) LTFU or 2) Uptake of PMTCT services. As part of a randomized control trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services, newly-diagnosed HIV-infected women, ≤32 weeks pregnant, registering for antenatal care (ANC), in 85 clinics in Kinshasa, Democratic Republic of Congo (DRC), were recruited and followed-up until LTFU, death, transfer out, or six-weeks postpartum. Participants were interviewed at enrollment using a questionnaire which included the Patient Health Questionnaire (PHQ-9). Depression was defined as a PHQ-9 score of ≥15. Among 433 women enrolled, 51 (11.8%) had a PHQ-9 score ≥15 including 15 (3.5%) with a score ≥20. At six weeks postpartum, 67 (15.5%) were LFTU and 331 (76.4%) were in care and had accepted all available PTMCT services. Of participants with depression at enrollment, 17.7% (9/51) were LTFU at six weeks postpartum compared to 15.2% (58/382) among those without, but the association was not statistically significant. On the other hand, 78.4% (40/51) of participants with prenatal depression were in care at six weeks postpartum and had attended all their scheduled visits and accepted available services compared to 76.2% (291/382) among those without depression. In this cohort of newly-diagnosed HIV-infected pregnant women, prenatal depression assessed with a PHQ-9 score ≥15 was not a strong predictor of LTFU among newly-diagnosed HIV-infected women in Kinshasa, DRC.

AbstractOver half of the world's displaced persons live in urban areas of developing countries. As they settle into countries with already strained health services, urban refugees face a unique set of challenges related to accessing social and mental health services. Humanitarian policy can inadvertently exacerbate these problems. This article discusses the intersection of humanitarian policy and physical and mental wellbeing among the Rwandan urban-refugee community facing uncertain futures in Yaoundé, Cameroon, as the result of a Cessation Clause. This analysis drew from participant observation, focus groups and unstructured interviews with 30 Rwandan refugee households in Yaoundé, Cameroon, over 11 months in May–August 2016, May–August 2017 and February–June 2018. The theme of uncertain futures stemming from humanitarian policy changes as a source of anxiety about the future organically emerged from the Rwandan research participants. Our analysis highlights the need to review the impacts that global humanitarian policies have on refugees' wellbeing and the ways in which it can erode hope.

BackgroundTheoretical and methodological research on risk-taking practices often frames risk as an individual choice. While risk does occur at individual level, it is determined by aspirations which are connected to others and society. For many displaced women globally, these aspirations are often linked to the well-being of their children and other household members. This article explores the links between aspirations for the future, gendered household dynamics, and health risk-taking behavior among the Rwandan urban refugee community.MethodsThis analysis drew from participant observation, focus group discussions, and in-depth interviews with 49 male and 42 female household members from 36 Rwandan refugee households in Yaoundé, Cameroon. The fieldwork was conducted over 12 months between May-August 2016, May-August 2017, and February-August 2018.ResultsWe observed that while there was considerable convergence among household members in aspirations, there was considerable difference in risk-taking practices engaged to achieve them with women often assuming the greatest risks. These gendered realities of risk were not only related to structural concerns including access to different forms of capital, but also to socio-cultural gendered expectations of women, how risks were defined and justified, and household dynamics that drove the gendered reality of observed risk-behavior.ConclusionsHumanitarian programs and policies are distinctly finite in nature; focused on the short-term needs of persons affected by conflict. However, many humanitarian situations in the world are protracted. In the midst of these challenges, themes of future-orientation, possibilities, and shared aspirations for a better future emerge. These aspirations and the practices, including risk-taking practices that stem from them are central to understand if we are to ensure a just peace and stability in displaced communities throughout the developing world. Our analysis highlights the need to examine sociocultural dimensions related to hopes for the future, gender, and household dynamics as a way to understand risk behavior. We propose this can be done through a framework of precarious hope which we put forward in this paper, in which hope, agency, sociocultural and political economic contexts situate risk as a gendered practice of hope amidst constraint.

Recent public discourse on the possible threats posed by immigrant populations as potential perpetrators of crime seems to ignore the accumulating scholarly literature that shows that immigrants have a documented crime reducing effect on the general population in the United States. Yet, immigrants themselves are placed at heightened risk for a wide variety of victimization experiences. Their needs as victims of crime have rarely been studied. This study aims to partially fill that void by investigating how service providers funded to assist victims of crime work with and attempt to meet the needs of immigrants, including large numbers of refugees, in one large Midwest city. The states Attorney Generals office supported a needs assessment that included a focus on the needs of victims from immigrant (and other) underserved populations. We conducted 21 semi-structured interviews with key informants who had varying degrees of expertise serving crime victims from immigrant communities across the state. Interviews were audiotaped, transcribed, coded and analyzed using a collaborative, team-based approach. Our analysis describes the challenges faced by service providers serving immigrant victims and recommends directions for future research and policy.

AbstractIntroductionFemale and male sex workers experience heightened vulnerability to HIV and other health harms that are compounded by substance use, physical and sexual violence, and limited access to health services. In Kisumu, Kenya, where sex work is widespread and substance use is a growing public health concern, offering pre‐exposure prophylaxis (PrEP) for HIV prevention could help curtail the HIV epidemic. Our study examines "syndemics," or mutually reinforcing epidemics of substance use, violence and HIV, in relation to PrEP acceptability and feasibility among female and male sex workers in Kenya, one of the first African countries to approve PrEP for HIV prevention.MethodsFrom 2016 to 2017, sex workers in Kisumu reporting recent alcohol or drug use and experiences of violence participated in qualitative interviews on HIV risk and perspectives on health service needs, including PrEP programming. Content analysis identified themes relating to PrEP knowledge, acceptability, access challenges and delivery preferences.ResultsAmong 45 female and 28 male sex workers, median age was 28 and 25 respectively. All participants reported past‐month alcohol use and 91% of women and 82% of men reported past‐month drug use. Violence was pervasive, with most women and men reporting past‐year physical (96% women, 86% men) and sexual (93% women, 79% men) violence. Concerning PrEP, interviews revealed: (1) low PrEP knowledge, especially among women; (2) high PrEP acceptability and perceived need, particularly within syndemic contexts of substance use and violence; and (3) preferences for accessible, non‐stigmatizing PrEP delivery initiatives designed with input from sex workers.ConclusionsThrough a syndemic lens, substance use and violence interact to increase HIV vulnerability and perceived need for PrEP among female and male sex workers in Kisumu. Although interest in PrEP was high, most sex workers in our sample, particularly women, were not benefiting from it. Syndemic substance use and violence experienced by sex workers posed important barriers to PrEP access for sex workers. Increasing PrEP access for sex workers will require addressing substance use and violence through integrated programming.