Discursos y prácticas sexuales de usuarios de saunas gay. Una aproximación desde las masculinidades

Els homes que tenen sexe amb homes (HSH) són la població més afectada per la infecció del VIH/sida i altres infeccions de transmissió sexual (ITS) en la majoria dels països europeus, inclosa Espanya. Entre les diferents ofertes que utilitzen els HSH per al contacte sexual estan les saunes. L'objectiu d’aquesta tesi va ser analitzar, des de la perspectiva de les masculinitats, el procés de salut (sexualitat), malaltia (VIH i altres ITS) i atenció (prevenció) en diferents usuaris de saunes gai de Barcelona. La tesi es presenta mitjançant la compilació de tres articles. El primer, és un estudi qualitatiu realitzat amb HSH, procedents d'una cohort seronegativa al VIH, que havien estat contactats en saunes gai. El segon, és una revisió sistemàtica sobre les masculinitats i el VIH. El tercer, és un treball de camp, realitzat entre el 2012-2016, centrat exclusivament amb treballadors sexuals masculins que oferien els seus serveis sexuals en una sauna gai. Els principals resultats van ser congruents i suggereixen que l'hegemonia masculina relacionada amb respondre al risc i demostrar proeses sexuals és una construcció social que no és exclusiva del món heterosexual. Les pràctiques socials i sexuals dels HSH conflueixen entre l'hegemonia i la transgressió al visibilitzar formes alternatives d'identitats masculines. No obstant això, existeix escassa recerca en aquesta matèria a nivell mundial. Entre els HSH no tots gaudeixen del mateix estatus, factors com la immigració, el nivell socioeconòmic, l'orientació sexual, l'homofòbia interioritzada i l'edat estableixen diferents relacions amb el risc, la percepció del VIH i la salut. Entre les estratègies de prevenció van destacar realitzar intervencions en llocs de socialització gai, considerar el suport social i els determinants socials. Se suggereix potenciar aquelles polítiques que promoguin l'acceptació a la diversitat sexual i cultural des d'una perspectiva de gènere.Los hombres que tienen sexo con hombres (HSH) son la población más afectada por la infección del VIH/sida y otras infecciones de transmisión sexual (ITS) en la mayoría de los países europeos, incluida España. Entre las diferentes ofertas que utilizan los HSH para el contacto sexual están las saunas. El objetivo de esta tesis fue analizar, desde la perspectiva de las masculinidades, el proceso de salud (sexualidad), enfermedad (VIH y otras ITS) y atención (prevención) en diferentes usuarios de saunas gay de Barcelona. La tesis se presenta mediante la compilación de tres artículos. El primero, es un estudio cualitativo realizado con HSH, procedentes de una cohorte seronegativa al VIH, que habían sido contactados en saunas gay. El segundo, es una revisión sistemática sobre las masculinidades y el VIH. El tercero, es un trabajo de campo, realizado entre el 2012-2016, centrado exclusivamente con trabajadores sexuales masculinos que ofrecían sus servicios sexuales en una sauna gay. Los principales resultados fueron congruentes y sugieren que la hegemonía masculina relacionada con responder al riesgo y demostrar proezas sexuales es una construcción social que no es exclusiva del mundo heterosexual. Las prácticas sociales y sexuales de los HSH confluyen entre la hegemonía y la trasgresión al visibilizar formas alternativas de identidades masculinas. Sin embargo, existe escasa investigación en esta materia a nivel mundial. Entre los HSH no todos gozan del mismo estatus, factores como la inmigración, el nivel socioeconómico, la orientación sexual, la homofobia interiorizada y la edad establecen diferentes relaciones con el riesgo, la percepción del VIH y la salud. Entre las estrategias de prevención destacaron realizar intervenciones en lugares de socialización gay, considerar el soporte social y los determinantes sociales. Se sugiere potenciar las políticas que promuevan la aceptación a la diversidad sexual y cultural desde una perspectiva de género.Men who have sex with men (MSM) are the most affected population by HIV/AIDS and other sexually transmitted infections (STIs) in most European countries, including Spain. Gay saunas are one of the setting were MSM have sexual contact. The objective of this dissertation was to analyse, from masculinities perspective, the process of health (sexuality), disease (HIV and other STIs) and care (prevention) in different gay saunas users in Barcelona. The dissertation is presented through the compilation of three articles. The first, is a qualitative study of MSM, belonging to a cohort without HIV infection, who had been contacted in gay saunas. The second, is a systematic review, which addressed masculinities and HIV. The third is a fieldwork, conducted between 2012-2016 focused exclusively on male sex workers who offered their sexual services in a gay sauna. The main findings derived from studies are congruent and suggest that male hegemony related to responding to risk and demonstrating sexual prowess is a social construct that is not unique to the heterosexual world. The social and sexual practices of MSM converge between hegemony and transgression by making alternative forms of male identities visible. However, there is scarce research on the subject at the global level. Factors such as immigration, socioeconomic status, sexual orientation, internalized homophobia, and age have a different relationship with risk, HIV perception, and health among MSM. Among the prevention strategies, the most important were to implement interventions in places of socialization for gay, to consider social support and social determinants. The policies that promotes the acceptance of sexual and cultural diversity from a gender perspective should be strengthened

Are we leaving someone behind? A critical discourse analysis on the understanding of public participation among people with experiences of participatory research

Participatory research (PR) is on the rise. In Spain, PR is scarce in the field of health, although there is an increasing interest in the matter. A comprehensive understanding of the meanings and practical implications of "public participation" is essential to promote participation in health research. The aim of the study is to explore the discursive positions on PR among individuals with experience in participatory processes in different areas and how this understanding translates into practice. We conducted a critical discourse analysis of 21 individuals with experience in PR and participatory processes (13 women, 8 men), mainly from the field of health and other areas of knowledge. Sixteen were Spanish and the rest were from the United Kingdom (3), United States (1), and Canada (1). Interviews were conducted in person or by telephone. The fieldwork was conducted between March 2019 and November 2019. The dominant discourses on public participation are situated along two axes situated on a continuum: the purpose of public participation and how power should be distributed in public participation processes. The first is instrumental public participation, which sees participatory research as a tool to improve research results and focuses on institutional interests and power-decision making is hold by researchers and institutions. The second, is transformative public participation, with a focus on social change and an equitable sharing of decision-making power between the public and researchers. All discursive positions stated that they do not carry out specific strategies to include the most socially disadvantaged individuals or groups. A shift in the scientific approach about knowledge, along with time and resources, are required to move towards a more balanced power distribution in the processes involving the public

Prevention of HIV and other sexually transmitted infections by geofencing and contextualized messages with a gamified APP, UBESAFE : Design and creation study

Advances in the development of information and communication technologies have facilitated social and sexual interrelationships, thanks to the websites and apps created to this end. However, these resources can also encourage sexual contacts without appropriate preventive measures in relation to HIV and other sexually transmitted infections (STIs). How can users be helped to benefit from the advantages of these apps while keeping in mind those preventive measures? This study aimed to prevent STIs by helping users to remember preventive measures in the risky situations. We have used the design and creation methodology and have developed a software system. This system has two parts: an Android operating system app with emphasis on ubiquitous computing and gamification as well as a server with a webpage. First, a functional test with 5 men who have sex with men (MSM) allowed us to test the app with end users. In addition, a feasibility test with 4 MSM for a month allowed us to try the UBESAFE system with all its functionalities. The main output is a system called UBESAFE that is addressed to MSM. The system has two main parts: (1) an app that sends preventive contextualized messages to users when they use a contact app or when they are near a point where sexual contacts are likely and (2) a server part that was managed by the public health agency of Barcelona (ASPB), which preserves the quality and pertinence of messages and places and offers instant help to users. To increase users' adherence, UBESAFE uses a gamified system to engage users in the creation of preventive messages. Users increased the initial pool of messages by more than 100% (34/30) and created more than 56% (9/16) of places (named hot zones). The system helped MSM who used it to become conscious about HIV and other STIs. The system also helped the ASPB to stay in contact with MSM and to detect behaviors that could benefit from preventive measures. All functions were performed in a nonintrusive manner because users used the app privately. Furthermore, the system has shown how important it is to make users a part of the creation process as well as to develop apps that work by themselves and thus become useful to the users

Evaluación cualitativa de una intervención para reducir la pobreza energética

OBJECTIVE: To evaluate the “Energía, la justa” program, aimed at reducing energy poverty in the city of Barcelona, from the point of view of the target population and the workers involved in the intervention. METHODS: A qualitative, descriptive and exploratory pilot study was carried out, with a phenomenological approach. Twelve semi-structured interviews were conducted: to three users, three energy agents who performed interventions in the homes, and six professionals who participated in the program coordination. A thematic content analysis was carried out using Atlas-ti software. Interviews were conducted between October 2016 and March 2017. RESULTS: Trust in a contact person (e.g. social workers) facilitated the participation, although there were difficulties reaching people who had illegal energy supplies, immigrant women or immigrants who subrent properties. Regarding implementation, home visits, energy efficiency advice and the relationship with energy agents were the best assessed aspects. However, not being able to carry out reforms in deteriorated dwellings was considered a limitation. The program also contributed to raise awareness on energy rights, to save on utility bills and to generate tranquility and social support. CONCLUSIONS: Programs such as this one can promote energy empowerment and improve psychosocial status. However, strategies with a gender and equity perspective should be considered to reach other vulnerable groups.OBJETIVO: Conocer las valoraciones del programa “Energía, la justa” orientado a reducir la pobreza energética en la ciudad de Barcelona, desde la perspectiva de las personas destinatarias y de las personas trabajadoras involucradas en la intervención. MÉTODOS: Estudio piloto realizado con metodología cualitativa, de tipo descriptivo y exploratorio, analizado desde un enfoque fenomenológico. Se realizaron 12 entrevistas semi-estructuradas: a tres personas destinatarias, a tres agentes energéticos que realizaron intervención en los hogares y a seis profesionales que participaron en la coordinación del programa. Se realizó un análisis de contenido temático mediante el software Atlas-ti. Las entrevistas se realizaron entre octubre de 2016 y marzo de 2017. RESULTADOS: La confianza con una persona de contacto (por ejemplo, trabajadoras sociales) facilitó la participación, pero hubo dificultad para acceder a personas que tenían los suministros ilegales, mujeres inmigrantes o inmigrantes que subalquilaban pisos. Respecto a la implementación, las visitas domiciliarias, el asesoramiento en materia de eficiencia energética y la relación con los agentes energéticos, fueron los aspectos mejor valorados. Sin embargo, se consideró como limitación no poder realizar reformas en viviendas muy deterioradas. A nivel de impacto, el programa contribuyó al conocimiento de los derechos energéticos, a ahorrar en las facturas de los suministros y a generar mayor tranquilidad y soporte social. CONCLUSIONES: Programas como este fomentan el empoderamiento en materia energética y producen mejoras a nivel psicosocial. No obstante, se deberían desarrollar estrategias con perspectiva de género y de equidad para llegar a otros colectivos especialmente vulnerable

Women’s advancement and leadership in the biomedical research centres of Catalonia II: bringing about change

Women; Leadership; Biomedical research centresMujeres; Liderazgo; Centros de investigación biomédicaDones; Lideratge; Centres de recerca biomèdicaNew demands for biomedical research centres are related to gender balance in research teams, gender balance in decision-making, integrating gender in research, and the implementation of Gender-Equality Action Plans (GEAPs). Several approaches for the new demands andchallenges for gender equality where proposed in the Girona Summit. The approaches are related to: analysing gender equality issues, removing unconscious bias through cultural awareness, improving research by integrating a gender perspective, fostering women’s career advancement and development, ensuring gender balance and transparency in decision-making positions, modernising policies and management practices, and representing the points of view of each stakeholder (individual, research centre, funding agency and policy-maker). Although not exhaustive of all possible options, the value of these approaches is being formulated on the basis of the experiences of the delegates of the Catalan research centres. The Hypatia of Alexandria Charter was proposed, discussed, endorsed and signed by the 19 centres of health and biomedical research of Catalonia, and the policy-making and assessment responsibilities of the Health Department of the Catalan Government

Use and perceptions on reusable and non-reusable menstrual products in Spain: a mixed-methods study

Menstrual products are necessary goods for women and people who menstruate to manage menstruation. Understanding the use and perceptions of menstrual products is key to promote menstrual equity and menstrual health. This study aimed at assessing the use and perceptions on menstrual products among women and people who menstruate aged 18-55 in Spain. Methods. A mixed-methods study was conducted, including a cross-sectional nation-wide study (N=22,823), and a qualitative study (N=34). Results. Participants used a combination of products. Non-reusable products were the most used, while over half used reusable products. Usage changed when data were stratified by age, gender identification, completed education, country of birth and experiencing financial issues. It also varied between trans and cis participants. Menstrual products' use also shifted based on experiences of menstrual poverty and access to information and products. Overall, reusable products were perceived to be more acceptable than non-reusable. Barriers to use the menstrual cup were also identified, including experiences of menstrual inequity (e.g., menstrual poverty, lack of access to information or menstrual management facilities). Conclusion. Perceptions and choices of menstrual products need to be acknowledged, especially when designing and implementing menstrual policies to address menstrual inequity and menstrual health

Menstrual health and period poverty among young people who menstruate in the Barcelona metropolitan area (Spain) : protocol of a mixed-methods study

The importance of menstrual health has been historically neglected, mostly due to taboos and misconceptions around menstruation and androcentrism within health knowledge and health systems around the world. There has also been a lack of attention on 'period poverty', which refers to the financial, social, cultural and political barriers to access menstrual products and education. The main aim of this research is to explore menstrual health and experiences of period poverty among young people who menstruate (YPM). This is a convergent mixed-methods study, which will combine a quantitative transversal study to identify the prevalence of period poverty among YPM (11-16 years old), and a qualitative study that will focus on exploring menstruation-related experiences of YPM and other groups (young people who do not menstruate (YNM); primary healthcare professionals; educators and policy-makers). The study will be conducted in the Barcelona metropolitan area between 2020 and 2021. Eighteen schools and 871 YPM will be recruited for the quantitative study. Sixty-five YPM will participate in the qualitative study. Forty-five YNM and 12 professionals will also be recruited to take part in the qualitative study. Socioeconomic and cultural diversity will be main vectors for recruitment, to ensure the findings are representative to the social and cultural context. Descriptive statistics will be performed for each variable to identify asymmetric distributions and differences among groups will be evaluated. Thematic analysis will be used for qualitative data analyses Several ethical issues have been considered, especially as this study includes the participation of underage participants. The study has received ethical approval by the IDIAPJGol Research Ethics Committee (19/178 P). Research findings will be disseminated to key audiences, such as YPM, YNM, parents/legal tutors, health professionals, educators, youth (and other relevant) organisations, general community members, stakeholders and policy-makers, and academia

Multiple health behaviour change primary care intervention for smoking cessation, physical activity and healthy diet in adults 45 to 75 years old (EIRA study): a hybrid effectiveness-implementation cluster randomised trial

Health behaviour; Health promotion; Hybrid trialComportamiento de salud; Promoción de la salud; Prueba híbridaComportament de salut; promoció de la salut; Prova híbridaBackground This study aimed to evaluate the effectiveness of a) a Multiple Health Behaviour Change (MHBC) intervention on reducing smoking, increasing physical activity and adherence to a Mediterranean dietary pattern in people aged 45–75 years compared to usual care; and b) an implementation strategy. Methods A cluster randomised effectiveness-implementation hybrid trial-type 2 with two parallel groups was conducted in 25 Spanish Primary Health Care (PHC) centres (3062 participants): 12 centres (1481 participants) were randomised to the intervention and 13 (1581 participants) to the control group (usual care). The intervention was based on the Transtheoretical Model and focused on all target behaviours using individual, group and community approaches. PHC professionals made it during routine care. The implementation strategy was based on the Consolidated Framework for Implementation Research (CFIR). Data were analysed using generalised linear mixed models, accounting for clustering. A mixed-methods data analysis was used to evaluate implementation outcomes (adoption, acceptability, appropriateness, feasibility and fidelity) and determinants of implementation success. Results 14.5% of participants in the intervention group and 8.9% in the usual care group showed a positive change in two or all the target behaviours. Intervention was more effective in promoting dietary behaviour change (31.9% vs 21.4%). The overall adoption rate by professionals was 48.7%. Early and final appropriateness were perceived by professionals as moderate. Early acceptability was high, whereas final acceptability was only moderate. Initial and final acceptability as perceived by the participants was high, and appropriateness moderate. Consent and recruitment rates were 82.0% and 65.5%, respectively, intervention uptake was 89.5% and completion rate 74.7%. The global value of the percentage of approaches with fidelity ≥50% was 16.7%. Eight CFIR constructs distinguished between high and low implementation, five corresponding to the Inner Setting domain. Conclusions Compared to usual care, the EIRA intervention was more effective in promoting MHBC and dietary behaviour change. Implementation outcomes were satisfactory except for the fidelity to the planned intervention, which was low. The organisational and structural contexts of the centres proved to be significant determinants of implementation effectiveness

Improving the detection of infectious diseases in at-risk migrants with an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care : a pilot cluster-randomized-controlled trial

There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including human immunodeficiency virus (HIV), hepatitis B and C, active tuberculosis (TB), Chagas disease, strongyloidiasis and schistosomiasis, based on patient characteristics (including variables of country of origin, age and sex). A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on international standard randomised controlled trial number (ISRCTN) (ISRCTN14795012). A total of 15 780 migrants registered across the eight centres had at least one visit during the intervention period (March-December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group [odds ratio: 2.08, 95% confidence interval (CI) 1.63-2.64, P < 0.001]. The intervention centres raised their overall monthly diagnosis rate to 5.80 (95% CI 1.23-10.38, P = 0.013) extra diagnoses compared with the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases [2.72 (95% CI 0.43-5.00); P = 0.02] and was observed as well for the parasitic infections' group (Chagas disease, strongyloidiasis and schistosomiasis) 2.58 (95% CI 1.60-3.57; P < 0.001). The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries