Neoliberalismo, colonialismo y derecho a la salud mental de la niñez en Puerto Rico

According to the World Health Organization (2008), inequalities and inequities in health are the result of social and economic policies that have crucial effects on the possibilities for a child to develop his or her potential, or simply lose his or her life. Because of the colonial relationship of Puerto Rico with the United States, it is essential to analyze how federal policy, changes in the global economy, and local neoliberal discourses that support privatization inform policies that address child rights. This paper seeks to explore and illustrate the impact of recent neoliberal mental health policies on health rights. Recommendations relevant to the field of social work are discussed with the ultimate goal of reflecting and promoting ethical political actions in the profession.De acuerdo a la Organización Mundial de la Salud (2008), las desigualdades y la inequidad en salud son el resultado de políticas sociales y económicas que tienen efectos determinantes en las posibilidades de que un/a niño/a desarrolle su potencial, tenga una vida plena o se malogre. En el caso de Puerto Rico, la injerencia de la política federal dentro de la esfera social y económica por nuestra relación colonial con los Estados Unidos, las transformaciones en la economía mundial, y el discurso de privatización dentro del espacio de lo político amparado en el neoliberalismo son elementos esenciales de análisis para las políticas sociales y económicas en torno a los derechos de la niñez, siendo la salud y salud mental los enfoques de este artículo. Este trabajo tiene el propósito de abordar brevemente el impacto de algunas de las más recientes políticas neoliberales en el campo de la salud mental, así como algunos ejemplos y efectos de la política colonial en el espacio del derecho a la salud. Se hacen recomendaciones a la profesión del Trabajo Social con el interés de provocar algunas reflexiones que dirijan acciones ético políticas en este campo profesional

Interacción familiar y estigma social en personas que viven con VIH y SIDA en Puerto Rico

This article aims to describe the manifestation of HIV stigma in the family context and how this could impact the life of people living with HIV (PLWH). The data derive from a larger phenomenological study addressing manifestations of stigma in the lives of PLWH when interacting with the health sector. Nine focus groups were carried out in 2011 with PLWH (N=67). Eight themes emerged from the qualitative analysis. For the purpose of this article, we focus on the categories related to family dynamics: the negotiation of disclosure and non-disclosure, fear of the HIV virus and family dynamics, and life as a couple. Socio demographic information showed that 53% were between 44 to 54 years old, 80% were single, 51% were male, 42% did not complete a high school diploma, 82% were unemployed. Also, 82% described themselves as religious persons and 41% had lived with HIV for 10 years or less. Qualitative results show stigma is still present in the family context. PLWH experience fear of disclosure, discrimination, avoid initiating families or couple relationships, experience physical and verbal abuse from relatives, and even separation from other family members. After more than 30 years of the ongoing HIV epidemic, stigma is still manifested by family members with detrimental social and medical implications for PLWH. Research and educational efforts should continue addressing manifestations of stigma among family members of PLWH.Este artículo tiene el propósito de describir las manifestaciones de estigma hacia el VIH en el contexto familiar y como ello pudiera impactar la vida de las personas que viven con VIH (PLWH). La data emana de un análisis de datos de una investigación fenomenológica más amplia que aborda las manifestaciones de estigma en la vida de las personas que viven con VIH en el escenario de la salud. Nueve grupos focales fueron realizados en el 2011 con PLWH (N=67). Ocho temas emergieron del análisis cualitativo. Para propósitos de este artículo, enfatizaremos en las categorías relacionadas a las dinámicas familiares: a) la negociación de revelar o no revelar la condición, el miedo al virus del VIH y las dinámicas familiares, y vida en pareja. Datos sociodemográficos demuestran que el 53% estaban entre los 44 a 54 años de edad, 80% eran soltero, 51% eran de género masculino, 42% no completó un diploma de escuela superior, y 82% estaba desempleado. Además, 82% se consideraba una persona religiosa, y 41% había vivido con VIH por 10 años o menos. Resultados cualitativos muestran que el estigma se encuentran aun presente en el contexto familiar. Las personas que viven con VIH experimentan miedo a revelar condición, discriminación, evitan iniciar relaciones familiares o vida en pareja, experimentan abuso físico y verbal de familiares. Luego de 30 años de la condición del VIH, el estigma aún se manifiesta a través de los familiares de personas que viven con VIH, teniendo implicaciones sociales y médicas detrimentales para ellos y ellas. Esfuerzos investigativos y de educación deben continuar abordando las manifestaciones del estigma entre familiares de personas que viven con el VIH.National Institute of Mental Health (3R01 MH080694-04S1), the National Institute of Drug Abuse (UCLA HA-STTP - R25 DA035692) & the National Institute on Minority Health and Health Disparities (R25MD007607)

Knowledge, Motivations and Concerns about Participation in Breast Cancer Clinical Trials in Puerto Rico

Clinical trials (CT) in breast cancer have been crucial for new treatment discoveries. While participation in cancer CT is low, minorities are particularly underrepresented.This study aimed toidentify factors influencing the participation in CTs based on the experiences of Latina breast cancer survivors in Puerto Rico (PR), especially their CT knowledge, motivations, and concerns.Method:Focus groups (FG) were conducted by two social workers and the University of Puerto Rico/MD Anderson Community Health Educator. Participants were stratified into two subgroups: a) women with CT experience and b) those without CT experience. Seven FG were completed among breast cancer survivors (n=34) at two hospitals from the PR metropolitan area. Results: Our findings showed that participants expressed a basic knowledge and understanding of clinical trials. Motivations to participate included a desire to help others, non-monetary incentives to participation, self-benefits, readiness to participate based on the phases of illness, and enhanced relationships with the clinical trial recruitment team. Regardless of their previous experience with CTs, participants expressed concerns about participation including limited of knowledge about trial procedures and results, and lack of transportation, childcare, and support from family. Recommendations: The barriers and motivations identified for CT participation are modifiable and best targeted using a multidisciplinary approach.Social workers could play a potential role in participant recruitment and retention by clarifying research protocols to potential participants, as well as conducting CT. Our findings can help enhance capacity and training efforts for health professionals involved in CT recruitment and retention in culturally-relevant ways

Niñez ciudadana: Un abordaje socio construccionista a la política de salud mental infanto-juvenil en Puerto Rico

Este trabajo tiene el propósito de presentar la situación de la problemática de salud mental infanto-juvenil en Puerto Rico desde los conceptos del socioconstruccionismo y la ciudadanía participativa. Se identifican rasgos sobresalientes y limitaciones dentro de la Ley de Salud Mental en Puerto Rico, según enmendada (Ley 408 del 2 de octubre del 2000) para la población infanto-juvenil con el fin de realizar recomendaciones a la profesión de Trabajo Social y otros profesionales de la conducta para la formulación de una política de salud mental en beneficio de esta población desde los referentes teóricos discutidos

"De los problemas del interior" y otros relatos: construcciones infanto-juveniles sobre la salud mental

Objective: This research paper discuss the notions of mental health and mental health condition from a group of children and youth between 10 to 17 years old, all of them participants of mental health services in Puerto Rico. Also, it has the purpose to analyze the implications those constructions have for public policy and services provision. The results are part of a larger study entitled: Invisible citizens: Diversity of voices about the mental health policy in Puerto Rico. Method: A sequential mix method approach was implemented (Creswell & Plano, 2007). This article will focus on data related to mental health and mental health condition constructions collected through the quantitative and qualitative phases. Results: 54.8% were females and 95.2% received mental health services from the public health care system. 64.3% said to have a mental health condition and 45.2% said to have two or more years in treatment. In the second phase, the mental health concept was identified from a pathology perspective or lack of health. The concept of mental health condition was identified from the symptoms associated to their own mental conditions. Conclusions: The mental health professionals should listen and understand these mental health constructions in order to provide effective mental health treatments.Objetivo: Este artículo profundiza sobre las nociones de salud mental y condición de salud mental en un grupo de niños/as y jóvenes de 10 a 17 años participantes de servicios de salud mental en Puerto Rico y analiza las implicaciones de estas construcciones para la política pública y los servicios. Los resultados presentados se hacen parte de una investigación titulada: Ciudadanos/as invisibles: Diversidad de voces sobre la política de salud mental en Puerto Rico. Método: Para esta investigación se desarrolló un diseño de método mixto secuencial de seguimiento de participantes (Creswell & Plano, 2007). Este artículo solo abordará los datos relacionados a la definición de salud mental y condición de salud mental recopilada a través de la fase cuantitativa y cualitativa. Resultados: El 54.8% fueron del sexo femenino y 95.2% fueron pacientes del sistema de atención pública del gobierno. El 64.3% indicó tener una condición de salud mental y 45.2% reportó más de dos años en tratamiento. En la segunda fase, el concepto de salud mental fue definido desde la patología. El concepto de condición de salud mental fue definido desde los síntomas que éstos padecían. Asuntos de estigma fueron resaltados. Conclusiones: Los profesionales de la salud deben proveer espacios de escucha y comprender las construcciones alrededor de la salud mental para proveer tratamientos efectivos

Factores socio-estructurales y el estigma hacia el VIH/SIDA: experiencias de puertorriqueños/as con VIH/SIDA al acceder a servicios de salud

HIV/AIDS stigma continues affecting the provision of health services to people living with HIV/AIDS, as well as their physical and mental well-being. Scientific literature has highlighted the importance of understanding stigma manifestations that surpass one-on-one social interactions. For that reason, social research in Puerto Rico and elsewhere has highlighted the importance of understanding the Socio-Structural Factors (SSF) that foster HIV/AIDS stigma. With the objective of exploring the SSF that influence stigma manifestations related to HIV/AIDS, we conducted 9 focus groups composed by women and men on HIV/AIDS treatment that had experienced social stigma related to the disease. Participants identified SSF that they understood were related to stigma such as a) development of housing projects for people with HIV/AIDS, b) decentralization of health related services, and c) health services administrative protocols that fostered exclusion. Results evidence the importance of addressing SSF when developing stigma related interventions for this population.El estigma relacionado al VIH/SIDA continúa afectando la prestación de servicios de salud y el bienestar físico y mental de las personas con VIH/SIDA (PVS). Recientemente la literatura científica ha señalado la importancia de comprender las manifestaciones de estigma más allá de las interacciones individuales. Por tal razón, investigaciones recientes en y fuera de Puerto Rico enfatizan la importancia de entender cómo factores socio-estructurales (FSE) influyen en los procesos de estigmatización social. Con el propósito de examinar los FSE que influyen en las manifestaciones de estigma relacionado al VIH/SIDA, realizamos y analizamos nueve grupos focales compuestos por hombres y mujeres en tratamiento para el VIH/SIDA que habían tenido experiencias estigmatizantes. Los participantes identificaron FSE relacionados a las manifestaciones de estigma, tales como el uso de viviendas especializadas, descentralización de los servicios de salud y el desarrollo de protocolos administrativos excluyentes en los servicios de salud. Los resultados demuestran la importancia de considerar los FSE en el desarrollo e implementación de intervenciones dirigidas a la población

Family interaction and social stigmatization of people leaving with HIV and AIDS in Puerto Rico

This article aims to describe the manifestation of HIV stigma in the family context and how this could impact the life of people living with HIV (PLWH). The data derive from a larger phenomenological study addressing manifestations of stigma in the lives of PLWH when interacting with the health sector. Nine focus groups were carried out in 2011 with PLWH  (N=67). Eight themes emerged from the qualitative analysis. For the purpose of this article, we focus on the categories related to family dynamics: the negotiation of disclosure and non-disclosure, fear of the HIV virus and family dynamics, and life as a couple.  Socio demographic information showed that 53% were between 44 to 54 years old, 80% were single, 51% were male, 42% did not complete a high school diploma, 82% were unemployed. Also, 82% described themselves as religious persons and 41% had lived with HIV for 10 years or less. Qualitative results show stigma is still present in the family context. PLWH experience fear of disclosure, discrimination, avoid initiating families or couple relationships, experience physical and verbal abuse from relatives, and even separation from other family members. After more than 30 years of the ongoing HIV epidemic, stigma is still manifested by family members with detrimental social and medical implications for PLWH. Research and educational efforts should continue addressing manifestations of stigma among family members of PLWH.This article aims to describe the manifestation of HIV stigma in the family context and how this could impact the life of people living with HIV (PLWH). The data derive from a larger phenomenological study addressing manifestations of stigma in the lives of PLWH when interacting with the health sector. Nine focus groups were carried out in 2011 with PLWH  (N=67). Eight themes emerged from the qualitative analysis. For the purpose of this article, we focus on the categories related to family dynamics: the negotiation of disclosure and non-disclosure, fear of the HIV virus and family dynamics, and life as a couple.  Socio demographic information showed that 53% were between 44 to 54 years old, 80% were single, 51% were male, 42% did not complete a high school diploma, 82% were unemployed. Also, 82% described themselves as religious persons and 41% had lived with HIV for 10 years or less. Qualitative results show stigma is still present in the family context. PLWH experience fear of disclosure, discrimination, avoid initiating families or couple relationships, experience physical and verbal abuse from relatives, and even separation from other family members. After more than 30 years of the ongoing HIV epidemic, stigma is still manifested by family members with detrimental social and medical implications for PLWH. Research and educational efforts should continue addressing manifestations of stigma among family members of PLWH.

Family interaction and social stigmatization of people living with HIV and AIDS in Puerto Rico

This article aims to describe the manifestation of HIV stigma in the family context and how this could impact the life of people living with HIV (PLWH). The data derive from a larger phenomenological study addressing manifestations of stigma in the lives of PLWH when interacting with the health sector. Nine focus groups were carried out in 2011 with PLWH  (N=67). Eight themes emerged from the qualitative analysis. For the purpose of this article, we focus on the categories related to family dynamics: the negotiation of disclosure and non-disclosure, fear of the HIV virus and family dynamics, and life as a couple.  Socio demographic information showed that 53% were between 44 to 54 years old, 80% were single, 51% were male, 42% did not complete a high school diploma, 82% were unemployed. Also, 82% described themselves as religious persons and 41% had lived with HIV for 10 years or less. Qualitative results show stigma is still present in the family context. PLWH experience fear of disclosure, discrimination, avoid initiating families or couple relationships, experience physical and verbal abuse from relatives, and even separation from other family members. After more than 30 years of the ongoing HIV epidemic, stigma is still manifested by family members with detrimental social and medical implications for PLWH. Research and educational efforts should continue addressing manifestations of stigma among family members of PLWH.

Tecnología móvil como herramienta potencial en la investigación sobre estigma asociado al VIH/SIDA entre estudiantes de medicina

La identificación y reducción de manifestaciones de estigma asociado al VIH/SIDA entre profesionales de la salud continúa presentando retos importantes. Algunos de estos es la medición en espacios tan complejos como los escenarios clínicos. No obstante, con el surgimiento de la tecnología móvil durante los últimos años, tales como teléfonos inteligentes y tabletas, se potencia una mejor exploración de las manifestaciones del estigma a través de la investigación y su potencial reducción. El presente artículo tiene como objetivo reflexionar sobre la capacidad de la tableta iPad para medir las manifestaciones de estigma asociado al VIH/SIDA dentro de un escenario clínico controlado con estudiantes de medicina. El mismo está basado en una experiencia investigativa llevada a cabo para medir manifestaciones conductuales del estigma asociado al VIH/SIDA entre estudiantes de medicina en Puerto Rico. El estudio integró el uso de iPad en la recopilación, almacenamiento y análisis de datos. Este artículo resalta el uso de aplicaciones (Apps) ya existentes para iPad para la implementación de instrumentos digitales para medir estigma hacia el VIH/SIDA. Al discutir la experiencia de los/as investigadores/as, se resalta el potencial del iPad y sus aplicaciones para la investigación sobre estigma. De igual forma, implicaciones sobre el uso de tecnología móvil en la investigación social son discutidas

HIV/AIDS stigma manifestations during clinical interactions with MSM in Puerto Rico

HIV/AIDS stigma can have detrimental effects on physician/patient interactions when manifested by health professionals. Unfortunately, HIV/AIDS stigma is usually manifested in an intersectional manner with other preexisting stigmas, including stigma toward men who have sex with men (MSM). Therefore, our study aimed to examine the behavioral manifestations of HIV/AIDS stigma among physicians in training during simulated clinical interactions with MSM, and explore the interrelation between HIV/AIDS stigma attitudes and behaviors. We implemented an experimental design using Standardized Patient simulations with a sample of 100 physicians in training in Puerto Rico. Results show a significant difference in the two groups’ means (p \u3c.001), with a higher number of stigma behaviors in the HIV MSM patient condition (M = 6.39) than the common cold control condition (M = 5.20). Results evidence that stigma manifestations toward MSM with HIV may continue to be an obstacle for public health in Puerto Rico, and that medical training to prevent stigma is still needed