Improving Breast Cancer Control via the Use of Community Health Workers in South Africa: A Critical Review

Breast cancer is a growing concern in low- and middle-income countries (LMCs). We explore community health worker (CHW) programs and describe their potential use in LMCs. We use South Africa as an example of how CHWs could improve access to breast health care because of its middle-income status, existing cancer centers, and history of CHW programs. CHWs could assume three main roles along the cancer control continuum: health education, screening, and patient navigation. By raising awareness about breast cancer through education, women are more likely to undergo screening. Many more women can be screened resulting in earlier-stage disease if CHWs are trained to perform clinical breast exams. As patient navigators, CHWs can guide women through the screening and treatment process. It is suggested that these roles be combined within existing CHW programs to maximize resources and improve breast cancer outcomes in LMCs

Experiences of Heterosexist Events and Effects of Political Context on the Perceived Visibility and Mental Health of LGBQ+ Individuals

In the present study the concept of perceived visibility of LGBQ+ identity is explored in relation to heterosexist experiences, political context, and the mental health of LGBQ+ individuals living in the United States. Donald Trump’s presidency was expected by many to have a negative effect on LGBTQ+ rights and, as a result, mental well-being. In this study a convenience sample of 363 LGBTQ+ individuals completed an online survey which included questions about outness of their LGBTQ+ identities including perceived visibility, symptoms of depression and anxiety, heterosexist experiences, internalized heterosexism (IH), gender expression, political orientation, and geographic location. As expected, perceived visibility (PV) had a significant, positive correlation with the Outness Inventory and a significant, negative correlation with the Self-Concealment Scale. Of the demographic variables, PV had a significant association with only gender expression conformity (GEC). In a model predicting 12% of the variance in mean safety concerns, gender identity and education were significant predictors while overall PV, race and ethnicity, GEC, population density, and conservative voting were not. Gender identity, gender expression, and conformity of gender expression to the traditional masculine/feminine binary were found to be significant predictors of heterosexist experiences and safety concerns. Gender identity as transgender, non-binary, or another non-cisgender identity was a predictor of higher safety concerns. IH was a significant mediator of the relationship between overall PV and depressive symptoms, suggesting that the association between PV and depressive symptoms was attenuated by internalized stigma. The Gender Expression, Vigilance, Discrimination and Harassment, and Victimization subscales of the Daily Heterosexist Experiences Questionnaire also were mediators of the relationships between overall PV and the GAD-7, PV and a politically-oriented GAD-7, and PV and the CES-D. Overall PV was a significant predictor of heterosexist events related to vigilance, discrimination, harassment, family of origin, and victimization, when controlling for race and ethnicity, safety concerns, GEC, and conservative-liberal identity. Since the 2016 U.S. Presidential election, more than 30% of participants reported that their overall PV had changed, as a result of the election of Donald Trump. Implications of study findings are discussed. Study limitations and directions for future research also are explored