Debe cuidarse en la calle : normative influences on condom use among the steady male partners of female sex workers in the Dominican Republic

Encouragement to use condoms reflects the injunctive norm, or idea that you should use condoms. In our previous research with the regular male partners of female sex workers in the Dominican Republic, we found that encouragement to use condoms with female sex workers from individuals in their personal social networks was not directly associated with condom use. In the current study, we used qualitative interviews to further explore the influence of social network norms on men's sexual risk behaviours. We interviewed eleven steady male partners of female sex workers; participants completed two interviews to achieve greater depth. We analysed data using analytic summaries and systematic thematic coding. All men perceived that the prevailing injunctive norm was that they should use condoms with sex workers. Men received encouragement to use condoms but did not articulate a link between this encouragement and condom use. Additionally, men who did not use condoms lied to their friends to avoid social sanction. Findings highlight that the influence of a pro-condom injunctive norm is not always health promoting and can even be negative. HIV prevention efforts seeking to promote condom use should address the alignment between injunctive and descriptive norms to strengthen their collective influence on behaviour

Saliendo Adelante: Stressors and Coping Strategies Among Immigrant Latino Men Who Have Sex With Men in a Nontraditional Settlement State

Immigrant Latino men who have sex with men (MSM) are marginalized along multiple dimensions (e.g., ethnicity, sexual orientation, language use), which can negatively affect their health and well-being. As little is known about how this subgroup experiences the stress of marginalization and how, in turn, they cope with such stress, this study investigated stressors and coping strategies to better understand the factors shaping Latino MSM health. Assisted by a community advisory committee, we conducted in-depth interviews with 15 foreign-born Latino MSM in a nontraditional settlement state. Drawing on grounded theory methods, we analyzed transcripts iteratively to identify processes and characterize themes. Results were confirmed in member check interviews (n = 4) and findings were further contextualized through key informant interviews (n = 3). Participants reported ubiquitous, concurrent stressors due to being an immigrant, being a sexual minority, and being working poor. In particular, homophobia within families and local Latino communities was seen as pervasive. Some participants faced additional stressors due to being undocumented and not being Mexican. Participants drew on four types of coping strategies, with no dominant coping response: passive coping (i.e., not reacting to stressors); attempting to change stressors; seeking social support; and seeking distractions. Family ties, especially with mothers, provided key emotional support but could also generate stress related to participants’ sexuality. This study lays a foundation for future work and is particularly relevant for Latino MSM in nontraditional settlement states. Findings may inform future interventions to reduce stressors and increase resiliency, which can positively affect multiple health outcomes

Social networks, social participation, and health among youth living in extreme poverty in rural Malawi

Extensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth’s peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys. Youth exchanged social support and influence within their networks that helped cope with poverty-induced stress and sadness, and encouraged protective sexual health practices. However, poverty hampered their involvement in school, religious schools, and community organizations, directly through lack of required material means, and indirectly by reducing time and emotional resources and creating shame and stigma. Poverty alleviation policy holds promise for improving youth’s social wellbeing and mental and physical health by increasing their opportunities to form networks, receive social support, and experience positive influence

Care Transitions in Childhood Cancer Survivorship: Providers' Perspectives

Purpose: Most adolescent and young adult (AYA)-aged childhood cancer survivors develop physical and/or psychosocial sequelae; however, many do not receive long-term follow-up (LTF) critical for screening, prevention, and treatment of late effects. To develop a health services research agenda to optimize care models, we conducted qualitative research with LTF providers examining existing models, and successes and challenges in maintaining survivors' connections to care across their transition to adulthood

Marginalisation, discrimination and the health of Latino immigrant day labourers in a central North Carolina community

The morbidity and mortality of Latino immigrants in the United States (US) stem from a complex mix of policy, culture, discrimination, and economics. Immigrants working as day labourers may be particularly vulnerable to the negative influences of these social factors due to limited access to social, financial, and legal resources. We aimed to understand how the health of male Latino day labourers in North Carolina, US is influenced by their experiences interacting with their community and perceptions of their social environment. To respond to our research questions, we conducted three focus groups (n=9, n =10, n=10) and a photovoice project (n=5) with Latino male immigrants between October 2013 and March 2014. We conducted a thematic analysis of transcripts from the discussions in the focus groups and the group of Photovoice participants. We found that men's health and well-being were primarily shaped by their experiences and feelings of discrimination and marginalization. We identified three main links between discrimination/marginalization and poor health: (1) dangerous work resulted in workplace injuries or illnesses, (2) unsteady employment caused stress, anxiety and insufficient funds for health care, and (3) exclusionary policies and treatment resulted in limited healthcare accessibility. Health promotion with Latino immigrant men in new settlement areas could benefit from community-building activities, addressing discrimination, augmenting the reach of formal health care, and building upon the informal mechanisms that immigrants rely on to meet their health needs. Reforms to immigration and labour policies are also essential to addressing these structural barriers to health for these men

A qualitative study of women's network social support and facility delivery in rural Ghana

Similar to many sub-Saharan African countries, maternal mortality in Ghana ranks among the highest (39th) globally. Prior research has demonstrated the impact of social network characteristics on health facility delivery in sub-Saharan Africa. However, in-depth examination of the function of all members in a woman’s network, in providing various types of support for the woman’s pregnancy and related care, is limited. We qualitatively explore how women’s network social support influences facility delivery. Qualitative data came from a mixed methods evaluation of a Maternal and Newborn Health Referral project in Ghana. In 2015 we conducted in-depth interviews with mothers (n = 40) and husbands (n = 20), and 4 focus group interviews with mothers-in-law. Data were analyzed using narrative summaries and thematic coding procedures to first examine women’s network composition during their pregnancy and childbirth experiences. We then compared those who had homebirths versus facility births on how network social support influenced their place of childbirth. Various network members were involved in providing women with social support. We found differences in how informational and instrumental support impacted women’s place of childbirth. Network members of women who had facility delivery mobilized resources to support women’s facility delivery. Among women who had homebirth but their network members advocated for them to have facility delivery, members delayed making arrangements for the women’s facility delivery. Women who had homebirth, and their network members advocated homebirth, received support to give birth at home. Network support for women’s pregnancy-related care affects their place of childbirth. Hence, maternal health interventions must develop strategies to prioritize informational and instrumental support for facility-based pregnancy and delivery care

La situación económica: Social determinants of contraceptive use in rural Honduras

Contraceptive use is an important determinant of unintended pregnancy, but little is known about the social and structural factors that determine women’s contraceptive use in rural Honduras. In this study, we aim to characterize the individual and social determinants of contraceptive use among women in rural Honduras. In 2011 and 2012, we conducted 14 interviews and two focus groups with women 18 years and older. In our analysis, we created a family planning narrative for each participant and coded transcripts around key emergent themes related to these determinants. We found that social determinants – including poverty, gender dynamics, and availability of family planning methods – had a strong influence on contraceptive use among women in our sample. Study participants stated that they were faced with a difficult economic situation compounded by rising prices of basic goods and diminishing job opportunities. Paradoxically, at the same time that the economic situation led women to seek contraception, it also contributed to the structural barriers that limited their ability to obtain their method of choice and maintain continuous contraceptive use. Our findings suggest the need for multi-level efforts to create an enabling and sustainable environment for family planning among women in rural Honduras

Masculinity and HIV: Dimensions of Masculine Norms that Contribute to Men’s HIV-Related Sexual Behaviors

Numerous studies have documented a relationship between masculine norms and men’s HIV-related sexual behaviors, but intervening upon this relationship requires a nuanced understanding of the specific aspects of masculine norms that shape men’s sexual behaviors. We integrate theories on masculinities with empirical HIV research to identify specific dimensions of masculine norms that influence men’s HIV-related sexual behaviors. We identify three major dimensions of masculine norms that shape men’s sexual behavior: 1) uncontrollable male sex drive, 2) capacity to perform sexually, and 3) power over others. While the existing literature does help explain the relationship between masculine norms and men’s sexual behaviors several gaps remain including: a recognition of context-specific masculinities, an interrogation of the positive influences of masculinity, adoption of an intersectional approach, assessment of changes in norms and behaviors over time, and rigorous evaluations of gender-transformative approaches. Addressing these gaps in future research may optimize prevention efforts

Engaging Men as Promotores de Salud: Perceptions of Community Health Workers Among Latino Men in North Carolina

The promotor de salud, or community health worker (CHW) role, is highly feminized and little is known about how men view their participation in CHW programs. We conducted in-depth interviews with Latino men in North Carolina to explore this gap. We used systematic coding and display procedures informed by Grounded Theory to analyze the data. Men described their communities as lacking cohesion, making integration of Latino immigrants difficult. Most did not consider themselves leaders or feel they had leaders in their communities. Their perceptions of the feminized CHW role as well as the volunteer or low-paid nature of CHW work conflicted with men’s provider role. They also did not think they could perform the CHW role because they lacked education, skills, and broad networks. Efforts to increase male participation in CHW programs in new Latino immigrant destinations will need to understand and address these gender and migration-related dynamics in order to engage both women and men in improving the health of their communities

Abriendo Puertas: Baseline Findings from an Integrated Intervention to Promote Prevention, Treatment and Care among FSW Living with HIV in the Dominican Republic

Female sex workers (FSW) are often the focus of primary HIV prevention efforts. However, little attention has been paid to the prevention, treatment, and care needs of FSW living with HIV. Based on formative research, we developed an integrated model to promote prevention and care for FSW living with HIV in Santo Domingo, Dominican Republic, including (1) individual counseling and education; (2) peer navigation; (3) clinical provider training; and (4) community mobilization. We enrolled 268 FSW living with HIV into the intervention and conducted socio-behavioral surveys, sexually transmitted infection (STI) testing, and viral load (VL) assessments. We used multivariate logistic regression to identify behavioral and socio-demographic factors associated with detectable VL (>50 copies/mL) and STI prevalence. Over half of all participants (51.9%) had a detectable VL, even though most received HIV-related care in the last 6 months (85.1%) and were currently on anti-retroviral treatment (ART) (72.4%). Factors positively associated with a detectable VL included being 18–35 years of age (Adjusted Odds Ratio [AOR] 2.46, 95% CI 1.31–4.60), having ever used drugs (AOR 2.34, 95% CI 1.14–4.79), and having ever interrupted ART (AOR 3.09, 95% CI 1.44–6.59). Factors protective against having a detectable VL included being single (AOR 0.45, 95% 0.20–0.98) and being currently on ART (AOR 0.17, 95% CI 0.07–0.41). Nearly one-quarter (23.1%) had an STI, which was associated with being single (AOR 3.21, 95% CI 1.27–8.11) and using drugs in the last 6 months (AOR 3.54, 95% CI 1.32–9.45). Being on ART was protective against STI (AOR 0.51, 95% CI 0.26–1.00). Baseline findings indicate significant barriers to VL suppression and STI prevention among FSW living with HIV and highlight gaps in the continuum of HIV care and treatment. These findings have important implications for both the individual health of FSW and population-level HIV transmission dynamics