Geographic Heterogeneity in Influenza and Pneumonia Mortality in Hispanic Americans.

(1) Background: Influenza and pneumonia (IP) is a leading cause of death in the US. The hypothesis was tested that the mortality rate differential between Hispanic whites (HW) and non-Hispanic whites (NHW) from IP varied by geographic region in the US. (2) Methods: The CDC database for multiple causes of death between 1999-2018 was used for this study. For ages 25-84, age-adjusted mortality rates per 100,000 (AAMR) for IP were computed by Hispanic ethnicity in whites for 10 Health & Human Services (HHS) regions and for urbanization levels in HHS Region 2. (3) Results: AAMR for IP was 13.76 (13.62-13.9) in HW and 14.91 (14.86-14.95) in NHW (rate ratio 1.08). Among HHS regions, rates were generally lower in HW than in NHW with the major exception of HHS Region 2. The rate there was 21.78 (21.24-22.33) in HW, 36.5% greater (p < 0.05) than that in NHW of 15.71 (15.56-15.86). In large central metro areas of Region 2, the rate was 27.10 (26.36-27.83) in HW compared to 19.78 (19.47-20.09) in NHW. (4) Conclusion: The difference in AAMR from IP between HW and NHW varied by region and urbanization with much higher rates for HW than NHW only in metropolitan areas of New York and New Jersey.

South african sexual assault survivors' experiences of post-exposure prophylaxis and individualized nursing care: a qualitative study.

South African sexual assault survivors face the risk of potential HIV exposure, but relatively little is known about their experiences of post-exposure prophylaxis (PEP) and post-sexual assault care. Researchers conducted 10 semistructured interviews with sexual assault survivors who had participated in an initial quantitative study of a post-sexual assault intervention that administered PEP and provided proactive individualized follow-up care. The qualitative study examined survivors' experiences of PEP and their participation in the initial observational study itself. Participants demonstrated a range of emotional reactions to PEP, while almost all equated their study experiences to positive interactions with the study nurses who administered PEP and provided informal psychosocial support. The results highlight important opportunities for nurses to enhance the quality of post-sexual assault care in order to improve patients' emotional and psychosocial outcomes and potentially increase the likelihood of survivor PEP adherence.

Preventing human immunodeficiency virus infection among sexual assault survivors in Cape Town, South Africa: an observational study.

We describe 131 South African sexual assault survivors offered HIV post-exposure prophylaxis (PEP). While the median days completed was 27 (IQR 27, 28), 34% stopped PEP or missed doses. Controlling for baseline symptoms, PEP was not associated with symptoms (OR = 1.30, 95% CI = 0.66, 2.64). Factors associated with unprotected sex included prior unprotected sex (OR = 6.46, 95% CI = 3.04, 13.74), time since the assault (OR = 1.33, 95% CI = 1.12, 1.57) and age (OR = 1.30, 95% CI = 1.08, 1.57). Trauma counseling was protective (OR = 0.18, 95% CI = 0.05, 0.58). Four instances of seroconversion were observed by 6 months (risk = 3.7%, 95% CI = 1.0, 9.1). Proactive follow-up is necessary to increase the likelihood of PEP completion and address the mental health and HIV risk needs of survivors. Adherence interventions and targeted risk reduction counseling should be provided to minimize HIV acquisition.

Wellness programme and health policy development at a large faith-based organisation in Khayelitsha, South Africa.

This paper presents a case study of wellness programme and health policy development based on an HIV/AIDS organisation's Khayelitsha site in the Western Cape Province, South Africa. The study examines the different challenges that the organisation faces in relation to its predominantly low-income staff, donor-driven structure, its limited resources and organisational capacity, and the highly stressful and demanding nature of HIV-related treatment and care. This case study also examines the significant and contentious challenges lying in the organisation's faith-based identity. Research began with a review of civil society organisations' responses to HIV in sub-Saharan Africa, as well as related topics, such as South Africa's public health system, and health-seeking attitudes, beliefs and behaviours in high-risk South African communities. The organisation's health policy was analysed and 'workshopped' with multiple employees. Focus groups were conducted with mid-management and fieldwork staff in the Khayelitsha office, while a comprehensive, anonymous, wellness questionnaire was distributed in order to collect quantitative data. Data acquired from the questionnaire responses and the focus group discussions indicated that wellness programme and health policy development faces its greatest challenges on two fronts, namely due to a critical lack of organisational development and capacity, and a host of practical, social and cultural challenges among the most vulnerable people whom the NGO intends to serve. The study's primary recommendations include: taking its employees' cultural and social norms into consideration; addressing issues related to capacity and organisational development with the major donors; broadening the scope of its health policy to extend beyond issues related to HIV; and examining and clarifying expectations of employee behaviour in light of its identity as a faith-based organisation. The study also issues a secondary list of recommendations for other resource-constrained NGOs that also wish to develop and implement wellness programmes and health policies in their workplace.

The politics of invisibility: homophobia and low-income HIV-positive women who have sex with women.

HIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' perceptions of available support networks and patterns of disclosure in order to raise awareness of their struggle against HIV and homophobia and to assist in empowering the low-income HIV-positive WSW community.

The politics of invisibility: HIV-positive women who have sex with women and their struggle for support.

HIV-positive women who have sex with women (WSW) have been routinely overlooked by government researchers, health care providers, and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income African American and Latina HIV-positive WSW in particular face culturally based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work, and abuse. By analyzing 16 intensive interviews with low-income HIV-positive WSW of color, the author examined the physical, emotional, and psychological needs of this population and their methods of coping with HIV. Also examined were the participants' perceptions of available support networks, which were examined in order to raise awareness of the complex battle fought by these women against HIV and homophobia in the face of greater social, cultural, and economic strife.