Transplantation or rurality? Migration and HIV risk among Chinese men who have sex with men in the urban areas.

INTRODUCTION: Migration of men who have sex with men (MSM) from rural to urban areas is common across low- and middle-income countries and is widely believed to contribute to elevated HIV risk among migrant MSM in urban areas. Little consensus exists on whether their risk is due to their transplantation or their being from resource-constrained rural areas. This study seeks to clarify the relationship between migration and HIV risks by comparing differences in HIV-related risky sexual behaviours and healthcare utilization across competing conceptualizations of migratory statuses. METHODS: In July 2016, MSM ?16 years old currently residing in one of eight urban cities in China were recruited for an online cross-sectional survey, which collected information on socio-demographics, sexual behaviours, HIV care-seeking behaviours, and healthcare utilization. Based on a question about residency status, each participant was classified as an urban local resident, urban transplant, or rural transplant. Multivariable multinomial logistic regression was used to examine the associations between risky behaviours and healthcare utilization among these three groups. RESULTS: Among 2007 MSM, the proportion of local, urban transplant and rural transplant were 32% (648/2007), 24% (478/2007), and 44% (881/2007), respectively. Compared with urban local resident MSM, urban transplant MSM were more likely to have ever tested for HIV (adjusted odds ratio (aOR) = 1.39, 95% confidence interval (CI): 1.08 to 1.80). Compared with urban transplant MSM, rural transplant MSM were less likely to have utilized any governmental sexual health services in the past three months (aOR = 0.75, 95% CI: 0.60 to 0.93), ever tested for HIV (aOR = 0.77, 95% CI: 0.61 to 0.96), ever initiated antiretroviral therapy (ART) (aOR = 0.16, 95% CI: 0.05 to 0.52), and ever purchased sex (aOR = 0.57, 95% CI: 0.38 to 0.85). No other significant differences were found in sexual behaviours among three groups. CONCLUSIONS: The widely used local/migrant categorization obscures important differences in HIV risk present between urban/rural subgroups among them. Previous studies of HIV risks in Chinese "migrant" may have failed to consider the role of structural factors such as discrimination or barriers to healthcare when interpreting their findings of higher HIV prevalence in this population. Low ART uptake among rural transplant MSM in this study is particularly concerning and underscore the need for HIV-related interventions tailored for this group

Death in long-term care: focus groups and interviews identify strategies to alleviate staff burnout

Context: Interdisciplinary long-term care staff are being challenged with increasing numbers of resident deaths as well as complex resident and family needs. Studies warn that staff responses to the stress generated by residents’ deaths can lead to increased ill health, sick time, burnout, and attrition. Objectives: To alleviate and prevent workplace stress and burnout in staff related to long-term care resident deaths. Methods: Participatory action research design. Qualitative individual interviews and focus groups were carried out within five long-term care homes, Vancouver, British Columbia, Canada. Findings: Two key themes emerged: Challenges Staff Experienced and Supporting Action Strategies. Challenges are reported under five sub-themes: 1) Differing Expectations, 2) Communication, 3) Acknowledgement, 4) Support, and 5) Education. Supporting Action Strategies to minimize the impact of resident death on staff are presented under four sub-themes: 1) the Individual: Practice self-care, awareness, mindfulness; 2) Team: Enhance end-of-life comfort for residents, strengthen support for families, maximize the use of palliative and spiritual care; 3) Organization: Nurture supportive leadership, improve communication, education, resources and 4) Higher learning: Build palliative care/emotional preparation into the curriculum and promote long-term care as a specialist area of healthcare. Limitations: Results may not generalize to other practice contexts; long-term care homes studied are part of a faith-based organization. Implications: Long-term care policy and system changes are needed to support interdisciplinary care staff and provide them with tools, resources, and supports to prevent burnout and cope with the increasing stress of working in long-term care