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1.
Soc Sci Med ; 295: 113783, 2022 02.
Article in English | MEDLINE | ID: mdl-33642069

ABSTRACT

This commentary addresses the possibilities and pitfalls of putting intersectionality and syndemics into conversation with each other. We engage with two studies published in this issue: the first on the health-related vulnerabilities among LGBTQ + Latinx men in Orlando after the Pulse nightclub shooting, and the other on syndemic health issues brought about by social and structural inequities among young Black gay, bisexual, and other men who have sex with men (GBM). Both manuscripts suggest that intersectionality and sydemics can be integrated or possibly merged to build effective health equity focused interventions for marginalized populations. We, however, argue that there are several methodological, ontological, and epistemological challenges in bringing together intersectionality and syndemics. Our argument coalesces around three key points. First, we contend that while it is feasible to think of their integration as useful to the study of health disparities, syndemics offers no added benefit to health scholarship grounded in intersectional analysis. Second, we argue that assumptions of common ground between intersectionality and syndemics rest on equating theories of interaction and additivity with critiques of mutual configurations of ideology, power structures, and social categories. Finally, we maintain that if intersectionality and syndemics are to be in conversation with each other, it must be done with the recognition and examination of where each framework situates itself relative to methodology, praxis, and power. Using our own work and those of intersectional feminist scholars, we demonstrate how the stakes of intersectionality diverge radically from those of syndemics, and how syndemics has the potential to undermine the significance of intersectionality for addressing issues of health equity.


Subject(s)
Health Equity , Sexual and Gender Minorities , Homosexuality, Male , Humans , Intersectional Framework , Male , Syndemic
2.
Med Anthropol ; 40(7): 591-597, 2021 10.
Article in English | MEDLINE | ID: mdl-34107226

ABSTRACT

Anthropological approaches to "immigrant mental health" as an object of ethnographic inquiry can illuminate how psychosocial well-being - or decline - and the therapeutic realm of mental health is always enacted by a variety of institutions and social actors. The ways that mental health is understood and approached across different geographical and social settings are constitutive of a range of cultural meanings, norms, and social relations. The authors in this special section provide crucial insights into the landscape of immigrant mental health and how the experience of multiple exclusions influences collective psychosocial well-being. They also illustrate the extent to which narratives shape the production of knowledge around immigration and health, engendering direct effects on public policy, social imaginaries, and community health. Future research in the anthropology of immigration and mental health will need to further elucidate the structural underpinnings and racial capitalist origins of psychosocial decline.


Subject(s)
Emigrants and Immigrants , Emigration and Immigration , Anthropology, Medical , Humans , Mental Health , Public Policy
3.
AMA J Ethics ; 23(5): E410-417, 2021 05 01.
Article in English | MEDLINE | ID: mdl-34038350

ABSTRACT

HIV/AIDS exceptionalism promoted compassion, garnered funding, built institutions, and shaped regulatory and research agendas under emergency conditions. Globally, however, HIV/AIDS exceptionalism has further fragmented fragile health service delivery systems in vulnerable, marginalized communities and created perverse incentives to influence seropositive individuals' behaviors. Even where HIV epidemics are viewed as "controlled" or "resolved" (as in the United States), ending AIDS requires eliminating exceptionalism, normalizing justice-based approaches to HIV care, and explicitly acknowledging how power dynamics shape popular narratives and practices.


Subject(s)
Acquired Immunodeficiency Syndrome , Epidemics , HIV Infections , HIV Infections/epidemiology , Humans , Social Justice , United States
4.
Article in English | MEDLINE | ID: mdl-33918632

ABSTRACT

Little progress has been made to advance U.S. federal policy responses to growing scientific findings about cumulative environmental health impacts and risks, which also show that many low income and racial and ethnic minority populations bear a disproportionate share of multiple environmental burdens. Recent scholarship points to a "standard narrative" by which policy makers rationalize their slow efforts on environmental justice because of perceived lack of data and analytical tools. Using a social constructivist approach, ethnographic research methods, and content analysis, we examined the social context of policy challenges related to cumulative risks and impacts in the state of Maryland between 2014 and 2016. We identified three frames about cumulative impacts as a health issue through which conflicts over such policy reforms materialize and are sustained: (a) perceptions of evidence, (b) interpretations of social justice, and (c) expectations of authoritative bodies. Our findings illustrate that policy impasse over cumulative impacts is highly dependent on how policy-relevant actors come to frame issues around legislating cumulative impacts, rather than the "standard narrative" of external constraints. Frame analysis may provide us with more robust understandings of policy processes to address cumulative risks and impacts and the social forces that create health policy change.


Subject(s)
Ethnicity , Minority Groups , Environmental Health , Health Policy , Humans , Maryland , Social Justice
6.
AIDS Behav ; 25(6): 1954-1967, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33537918

ABSTRACT

Unmet needs can impede optimal care engagement, impacting the health and well-being of people living with HIV (PLWH); yet, whether unmet needs differ by care engagement status is not well understood. Using surveys and qualitative interviews, we examined and compared unmet needs for PLWH (n = 172) at different levels of care engagement. Unmet needs varied only slightly by care status. Survey findings revealed that provision of housing, emergency financial assistance, employment assistance, and food security were the greatest unmet need; for those in care, housing was the greatest unmet need, whereas for those sporadically in care or out of care, employment assistance was the greatest unmet needs. Qualitative interviews likewise illustrated that a lack of financial resources including insurance, housing, employment, and transportation presented barriers to care engagement across all care groups. Our findings indicate that unmet needs among PLWH are complex and multi-faceted across care engagement status.


Subject(s)
HIV Infections , Continuity of Patient Care , HIV Infections/drug therapy , Health Services Needs and Demand , Housing , Humans , Surveys and Questionnaires
7.
Med Anthropol Q ; 33(4): 557-578, 2019 12.
Article in English | MEDLINE | ID: mdl-31134635

ABSTRACT

Mexican women constitute an increasing proportion of labor migrants to the United States. They are segregated into a handful of low-wage occupations, disadvantaged by global economic forces and the social construction of gender within employment relations. Drawing on ethnographic research from Maryland's Eastern Shore, I explore experiences of everyday injury, disability, and instability among Mexican migrant women who work in the commercial crab processing industry, which is increasingly dependent on the H-2B visa program to fill seasonal, non-agricultural jobs. By focusing on the daily lives of Mexican migrant women who are part of this labor force, their health and social needs, and the gendered dimensions of labor migration, I document how temporary work programs institutionalize liminality as permanent mode of being. I suggest that migrant women, amid the extraordinary uncertainty brought about by the processes of recurrent migration, reorient and recalibrate themselves through modes of conduct to make life more ordinary.


Subject(s)
Health Services Accessibility , Occupational Health , Transients and Migrants , Women/psychology , Anthropology, Medical , Disability Evaluation , Female , Food Industry , Humans , Maryland , Mexico/ethnology , Seafood , Transients and Migrants/legislation & jurisprudence , Transients and Migrants/psychology
8.
AIDS Behav ; 23(4): 973-983, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30519903

ABSTRACT

Evidence suggests that racial disparities in the HIV care continuum persist in older age groups, particularly among African Americans. The objective of this systematic review was to identify factors that facilitate or hinder older African Americans' engagement in the HIV care continuum. For studies published between 2003 and 2018, we: (1) searched databases using keywords, (2) excluded non-peer-reviewed studies, (3) limited findings to older African Americans and the HIV care continuum, and (4) retrieved and summarized data focused on barriers and facilitators of the HIV care continuum. Among the 1023 studies extracted, 13 were included: diagnosis/testing (n = 1), engagement in care (n = 7), and antiretroviral adherence (n = 5). Barriers included lack of HIV risk awareness, routine testing, and healthcare access, stigma, and multimorbidities. Social support, health/medication literacy, and increased self-efficacy facilitated engagement. A targeted focus on older African Americans is needed to achieve national goals of improving HIV care and treatment outcomes.


Subject(s)
Anti-Retroviral Agents/therapeutic use , Black or African American/psychology , Continuity of Patient Care , HIV Infections/drug therapy , HIV Infections/psychology , Health Services Accessibility , Medication Adherence/psychology , Patient Acceptance of Health Care , Social Stigma , Aged , Aged, 80 and over , Aging , Female , HIV Infections/ethnology , Health Knowledge, Attitudes, Practice , Health Status Disparities , Humans , Medication Adherence/ethnology , Social Support
9.
Sex Transm Dis ; 45(7): 442-446, 2018 07.
Article in English | MEDLINE | ID: mdl-29465658

ABSTRACT

BACKGROUND: Congenital syphilis (CS) disproportionately affects racial and ethnic minority women, especially in the US South. Although CS is relatively easy and inexpensive to prevent through screening and treatment of pregnant women, CS cases have continued to rise and are concentrated in relatively few US counties and states. In 2010, Louisiana had the highest case rate in the country for primary, secondary, and CS, with the highest number of CS cases in northwest Louisiana, where Shreveport is located. METHODS: We conducted qualitative interviews with community members (women and frontline providers) living in Caddo Parish to obtain their views about factors that negatively impact CS prevention. RESULTS: Participants described impediments in the pathways for prevention of CS. Lack of sexual and reproductive health education, discontinuities and fragmentation in health care insurance coverage, a dearth of referral points for prenatal care, and difficulty finding prenatal care providers who accept Medicaid can delay timely and adequate care for pregnant women. Participants reported that low reimbursement for necessary injections and difficulty obtaining required medication challenged efforts to screen and treat pregnant women according to guidelines. CONCLUSIONS: Although CS is easily prevented, health system and policy obstacles in pathways to CS prevention and care may need remediation at state and local levels.


Subject(s)
Communicable Disease Control , Needs Assessment , Pregnancy Complications, Infectious/prevention & control , Public Health/statistics & numerical data , Syphilis, Congenital/prevention & control , Adolescent , Adult , Ethnicity , Female , Humans , Louisiana/epidemiology , Male , Population Surveillance , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/microbiology , Pregnant Women/psychology , Prenatal Care/economics , Prenatal Care/statistics & numerical data , Prenatal Diagnosis , Public Health/economics , Public Health/legislation & jurisprudence , Syphilis, Congenital/epidemiology , Young Adult
10.
Glob Public Health ; 13(8): 982-996, 2018 08.
Article in English | MEDLINE | ID: mdl-29322886

ABSTRACT

In biomedical, public health, and popular discourses, the 'end of AIDS' has emerged as a predominant way to understand the future of HIV research and prevention. This approach is predicated on structuring and responding to HIV in ways that underscore its presumed lifelong nature. In this article, I examine the phenomenon of HIV chronicity that undergirds the 'end of AIDS' discourse. In particular, I explore how the logic of HIV chronicity, induced by technological advances in treatment and global financial and political investments, intensifies long-term uncertainty and prolonged crisis. Focusing on over 10 years of anthropological and public health research in the United States, I argue that HIV chronicity, and subsequently, the 'end of AIDS' discourse, obscure the on-going HIV crisis in particular global communities, especially among marginalised and ageing populations who live in under-resourced areas. By tracing the 'end of AIDS' discourse in my field sites and in other global locations, I describe how HIV chronicity signals a continuing global crisis and persistent social precarity rather than a 'break' with a hopeless past or a promising future free from AIDS.


Subject(s)
Acquired Immunodeficiency Syndrome/psychology , Chronic Disease/psychology , Adolescent , Adult , Aged , Aging , Disease Eradication , Female , Humans , Interviews as Topic , Male , Middle Aged , Qualitative Research , Uncertainty , United States , Young Adult
11.
Curr Anthropol ; 58(4): 454-476, 2017 Aug.
Article in English | MEDLINE | ID: mdl-29075043

ABSTRACT

Drawing on comparative ethnographic fieldwork conducted in urban Mozambique, United States, and Sierra Leone, the article is broadly concerned with the globalization of temporal logics and how specific ideologies of time and temporality accompany health interventions like those for HIV/AIDS. More specifically, we explore how HIV-positive individuals have been increasingly encouraged to pursue healthier and more fulfilling lives through a set of moral, physical, and social practices called "positive living" since the advent of antiretroviral therapies. We describe how positive living, a feature of HIV/AIDS programs throughout the world, has taken root across varied political, social and economic contexts and how temporal rationalities, which have largely been under-examined in the HIV/AIDS literature, shape communities' responses and interpretations of positive living. Our approach is ethnographic and comparative, with implications for how anthropologists might think about collaboration and its analytical possibilities.


Subject(s)
Acquired Immunodeficiency Syndrome/ethnology , Anthropology, Cultural , Humans , Mozambique , Sierra Leone
12.
J Assoc Nurses AIDS Care ; 28(4): 518-531, 2017.
Article in English | MEDLINE | ID: mdl-28366556

ABSTRACT

Stigma is recognized as a barrier to the prevention, care, and treatment of HIV, including engagement in the HIV care continuum. HIV stigma in older Black women may be compounded by preexisting social inequities based on gender, age, and race. Using semi-structured interviews and survey questionnaires, we explore experiences of HIV stigma, retention in care, and antiretroviral therapy (ART) adherence in 35 older Black women with HIV from Prince George's County, Maryland. Study findings indicated that older Black women experienced high levels of HIV stigma, retention in care, and ART adherence. Findings suggest that experiences of HIV stigma were intensified for older Black women due to multiple stigmatized social positions. Participants also reported experiences of marginalization in health care that hindered retention in care and ART adherence. Interventions aimed at improving HIV prevention, care, and treatment outcomes should incorporate HIV stigma reduction strategies as core elements.


Subject(s)
Black People/psychology , Black or African American/psychology , HIV Infections/psychology , Medication Adherence/psychology , Patient Acceptance of Health Care , Social Stigma , Adult , Age Factors , Aging , Anti-Retroviral Agents/therapeutic use , Female , HIV Infections/drug therapy , HIV Infections/ethnology , Humans , Interviews as Topic , Maryland , Medication Adherence/ethnology , Middle Aged , Qualitative Research , Stereotyping , Surveys and Questionnaires
13.
PLoS One ; 12(4): e0174310, 2017.
Article in English | MEDLINE | ID: mdl-28369113

ABSTRACT

BACKGROUND: U.S. natural gas production increased 40% from 2000 to 2015. This growth is largely related to technological advances in horizontal drilling and high-volume hydraulic fracturing. Environmental exposures upon impacted communities are a significant public health concern. Noise associated with natural gas compressor stations has been identified as a major concern for nearby residents, though limited studies exist. OBJECTIVES: We conducted a pilot study to characterize noise levels in 11 homes located in Doddridge County, West Virginia, and determined whether these levels differed based on time of day, indoors vs. outdoors, and proximity of homes to natural gas compressor stations. We also compared noise levels at increasing distances from compressor stations to available noise guidelines, and evaluated low frequency noise presence. METHODS: We collected indoor and outdoor 24-hour measurements (Leq, 24hr) in eight homes located within 750 meters (m) of the nearest compressor station and three control homes located >1000m. We then evaluated how A-weighted decibel (dBA) exposure levels differed based on factors outlined above. RESULTS: The geometric mean (GM) for 24-hour outdoor noise levels at homes located <300m (Leq,24hr: 60.3 dBA; geometric standard deviation (GSD): 1.0) from the nearest compressor station was nearly 9 dBA higher than control homes (Leq,24hr: 51.6 dBA; GSD: 1.1). GM for 24 hour indoor noise for homes <300m (Leq,24hr: 53.4 dBA; GSD: 1.2) from the nearest compressor station was 11.2 dBA higher than control homes (Leq,24hr: 42.2 dBA; GSD: 1.1). Indoor average daytime noise for homes <300m of the nearest compressor stations were 13.1 dBA higher than control homes, while indoor nighttime readings were 9.4 dBA higher. CONCLUSIONS: Findings indicate that living near a natural gas compressor station could potentially result in high environmental noise exposures. Larger studies are needed to confirm these findings and evaluate potential health impacts and protection measures.


Subject(s)
Environmental Exposure/adverse effects , Natural Gas , Noise/adverse effects , Environmental Monitoring , Housing , Humans , Pilot Projects , Public Health , West Virginia
14.
Cult Health Sex ; 19(12): 1329-1343, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28418279

ABSTRACT

HIV-related stigma is a barrier to the prevention and treatment of HIV. For midlife and older Black women, the nature and intensity of HIV-related stigma may be compounded by their multiple marginalised social status based on gender, race, and age. We examined the perceptions and experiences of HIV-related stigma among midlife and older Black women living in Prince George's County, Maryland, USA. Between 2014 and 2015, we conducted semi-structured interviews with a sample of 35 midlife and older Black women living with HIV. Using a modified grounded theory approach, we explored emergent themes related to the manifestation and experience of intersectional stigma and changes in stigma experience over time. Our findings suggest that intersectional stigma is a central feature in midlife and older Black women's lives, with women reporting experiences of intersectional stigma at the interpersonal/familial, community, and institutional/structural levels. Although women acknowledged gradual acceptance of their HIV-positive status over time, they continued to experience negative responses related to gender, race, age, and disease. Our findings indicate that a more robust understanding of the impact of HIV-related stigma requires work to consider the complex manifestations of intersectional stigma among an increasingly aging population of Black women in the USA.


Subject(s)
Black or African American/psychology , HIV Infections/psychology , Racial Groups , Social Stigma , Adult , Female , Gender Identity , Grounded Theory , Humans , Interviews as Topic , Maryland , Qualitative Research
15.
J Immigr Minor Health ; 19(4): 939-946, 2017 08.
Article in English | MEDLINE | ID: mdl-27067310

ABSTRACT

Immigration to rural areas in new receiving communities like Maryland's Eastern Shore is growing. Despite a rapid rise in immigration and diminishing health system resources, little attention has been focused on barriers to health care access in this region for immigrants. A total of 33 in-depth key informant interviews with providers and immigrants were conducted. Qualitative analysis employing a constant comparison approach was used to explore emergent themes related to barriers to health care access for a growing immigrant population. Participants perceived limited health care resources, lack of health insurance coverage, high health expenditures, language barriers, and non-citizenship status as barriers to immigrants' access of health care. Findings imply that immigrants living and working on the rural Eastern Shore face serious barriers to health care access. Additional work on immigrant health in rural areas and the impacts of immigration to rural health systems are needed.


Subject(s)
Emigrants and Immigrants , Health Services Accessibility/statistics & numerical data , Rural Population , Adult , Communication Barriers , Female , Financing, Personal/statistics & numerical data , Humans , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , Language , Male , Maryland , Middle Aged , Qualitative Research , Undocumented Immigrants , Young Adult
16.
PLoS One ; 11(1): e0145368, 2016.
Article in English | MEDLINE | ID: mdl-26726918

ABSTRACT

The recent growth of unconventional natural gas development and production (UNGDP) has outpaced research on the potential health impacts associated with the process. The Maryland Marcellus Shale Public Health Study was conducted to inform the Maryland Marcellus Shale Safe Drilling Initiative Advisory Commission, State legislators and the Governor about potential public health impacts associated with UNGDP so they could make an informed decision that considers the health and well-being of Marylanders. In this paper, we describe an impact assessment and hazard ranking methodology we used to assess the potential public health impacts for eight hazards associated with the UNGDP process. The hazard ranking included seven metrics: 1) presence of vulnerable populations (e.g. children under the age of 5, individuals over the age of 65, surface owners), 2) duration of exposure, 3) frequency of exposure, 4) likelihood of health effects, 5) magnitude/severity of health effects, 6) geographic extent, and 7) effectiveness of setbacks. Overall public health concern was determined by a color-coded ranking system (low, moderately high, and high) that was generated based on the overall sum of the scores for each hazard. We provide three illustrative examples of applying our methodology for air quality and health care infrastructure which were ranked as high concern and for water quality which was ranked moderately high concern. The hazard ranking was a valuable tool that allowed us to systematically evaluate each of the hazards and provide recommendations to minimize the hazards.


Subject(s)
Environmental Exposure , Hazardous Substances , Natural Gas/toxicity , Humans , Maryland
17.
Soc Sci Med ; 151: 27-37, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26773295

ABSTRACT

We examined community perspectives and experiences with fracking in Doddridge County, West Virginia, USA as part of a larger assessment to investigate the potential health impacts associated with fracking in neighboring Maryland, USA. In November 2013, we held two focus groups with community residents who had been impacted by fracking operations and conducted field observations in the impacted areas. Employing grounded theory, we conducted qualitative analysis to explore emergent themes related to direct and indirect health impacts of fracking. Three components of experience were identified, including (a) meanings of place and identity, (b) transforming relationships, and (c) perceptions of environmental and health impacts. Our findings indicate that fracking contributes to a disruption in residents' sense of place and social identity, generating widespread social stress. Although community residents acknowledged the potential for economic growth brought about by fracking, rapid transformations in meanings of place and social identity influenced residents' perceptions of environmental and health impacts. Our findings suggest that in order to have a more complete understanding of the health impacts of fracking, future work must consider the complex linkages between social disruption, environmental impacts, and health outcomes through critical engagements with communities undergoing energy development.


Subject(s)
Environment , Environmental Monitoring/methods , Hydraulic Fracking/methods , Perception , Employment/standards , Employment/statistics & numerical data , Focus Groups , Humans , Hydraulic Fracking/standards , Hydraulic Fracking/statistics & numerical data , Social Change , West Virginia
18.
AIDS Patient Care STDS ; 27(2): 123-33, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23268586

ABSTRACT

Few studies have explored how overall general health care and HIV/STI testing experiences may influence receipt of "Seek, Test, Treat, and Retain" (STTR) HIV prevention approaches among Black men in the southern United States. Using in-depth qualitative interviews with 78 HIV-negative/unknown Black men in Georgia, we explored factors influencing their general health care and HIV/STI testing experiences. The Andersen behavioral model of health care utilization (Andersen model) offers a useful framework through which to examine the general health care experiences and HIV testing practices of Black men. It has four primary domains: Environment, Population characteristics, Health behavior, and Outcomes. Within the Andersen model framework, participants described four main themes that influenced HIV testing: access to insurance, patient-provider communication, quality of services, and personal belief systems. If STTR is to be successful among Black men, improving access and quality of general health care, integrating HIV testing into general health care, promoting health empowerment, and consumer satisfaction should be addressed.


Subject(s)
Black or African American , HIV Infections/prevention & control , Health Promotion , Mass Screening , Sexual Behavior/statistics & numerical data , Adult , HIV Infections/epidemiology , HIV Infections/psychology , Health Behavior , Health Knowledge, Attitudes, Practice , Health Services Accessibility , Health Status Disparities , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Power, Psychological , Qualitative Research , Sexual Behavior/psychology , United States/epidemiology
19.
Hum Organ ; 72(3): 263-272, 2013.
Article in English | MEDLINE | ID: mdl-29731518

ABSTRACT

Recent studies have documented frequent use of female sex workers among Latino migrant men in the southeastern United States, yet little is known about the context in which sex work takes place, or the women who provide these services. As anthropologists working in applied public health, we use rapid ethnographic assessment as a technical assistance tool to document local understandings of the organization and typology of sex work and patterns of mobility among sex workers and their Latino migrant clients. By incorporating ethnographic methods in traditional public health needs assessments, we were able to highlight the diversity of migrant experiences and better understand the health needs of mobile populations more broadly. We discuss the findings in terms of their practical implications for HIV/STD prevention and call on public health to incorporate the concept of mobility as an organizing principle for the delivery of health care services.

20.
Med Anthropol ; 31(4): 287-91, 2012.
Article in English | MEDLINE | ID: mdl-22746679

ABSTRACT

Although the production of national spaces, citizens, and populations through enumerative practices has been well explored in a variety of disciplines, anthropological methods and analysis can help to illuminate the everyday practices of enumeration, their unexpected consequences, and the co-construction of identities through these processes by both the "counted" and the "counters." The authors in this special issue illustrate how enumeration inflects lived experiences, produces subjectivities, and reconfigures governance. Focusing on the spatial, temporal, ideological, and affective dimensions of the techniques of enumeration, the authors also provide insights into the multiple forms of biopolitical expertise and knowledge that accumulate legitimacy through numerical discourse. They also highlight the ways in which governing structures, institutional and cultural norms, market logics, and rational-technical interventions influence the relationship among numerical categories, subjectivity, and everyday experience.


Subject(s)
Anthropology, Cultural , Anthropology, Medical , Epidemiologic Methods , Culture , Government , Humans , Politics
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