Stigmatization as a social control mechanism for persons living with HIV and AIDS.

Stigmatization contributes to inequity by marginalizing persons living with HIV and AIDS (PHAs). In this study we examined the stigmatizing practices in health care settings from the perspectives of PHAs and health care providers (HCPs). A qualitative design, using a participatory action research approach, was used. Interviews and focus groups were completed with 16 aboriginal and 17 nonaboriginal individuals living with HIV (APHAs and PHAs) and 27 HCPs in Ottawa and Edmonton, Canada. We present findings to support the premise that stigmatization can be used as a social control mechanism with PHAs. Participants described both active and passive social control mechanisms: shunning and ostracizing, labeling, and disempowering health care practices. Forgiving behavior, balancing disclosure, practicing universal precautions, bending the rules, shifting services, and reducing labeling were strategies to manage, resist, and mitigate social control. The findings illustrate the urgent need for multilevel interventions to manage, resist, and mitigate stigma.

Unpacking vertical and horizontal integration: childhood overweight/obesity programs and planning, a Canadian perspective.

BACKGROUND: Increasingly, multiple intervention programming is being understood and implemented as a key approach to developing public health initiatives and strategies. Using socio-ecological and population health perspectives, multiple intervention programming approaches are aimed at providing coordinated and strategic comprehensive programs operating over system levels and across sectors, allowing practitioners and decision makers to take advantage of synergistic effects. These approaches also require vertical and horizontal (v/h) integration of policy and practice in order to be maximally effective. DISCUSSION: This paper examines v/h integration of interventions for childhood overweight/obesity prevention and reduction from a Canadian perspective. It describes the implications of v/h integration for childhood overweight and obesity prevention, with examples of interventions where v/h integration has been implemented. An application of a conceptual framework for structuring v/h integration of an overweight/obesity prevention initiative is presented. The paper concludes with a discussion of the implications of vertical/horizontal integration for policy, research, and practice related to childhood overweight and obesity prevention multiple intervention programs. SUMMARY: Both v/h integration across sectors and over system levels are needed to fully support multiple intervention programs of the complexity and scope required by obesity issues. V/h integration requires attention to system structures and processes. A conceptual framework is needed to support policy alignment, multi-level evaluation, and ongoing coordination of people at the front lines of practice. Using such tools to achieve integration may enhance sustainability, increase effectiveness of prevention and reduction efforts, decrease stigmatization, and lead to new ways to relate the environment to people and people to the environment for better health for children.

Accessing health services while living with HIV: intersections of stigma.

AIDS stigma has serious consequences. This study explored those practices within health-care organizations that persons with HIV perceive as stigmatizing. It used an exploratory, descriptive design using a participatory action research approach. Interviews and focus groups were conducted with 16 Aboriginal and 17 non-Aboriginal persons living with HIV as well as with 27 health-care providers. The AIDS stigma perceived by many participants often intersected with other forms of stigma, related to behaviour, culture, gender, sexual orientation, or social class. In addition, policies at the organizational level contributed to AIDS stigma and at times intersected with stigma at the individual level. Participants' experiences of stigma and discrimination were shaped by the organizational policies (universal precautions, models of care) and design (physical layout) under which care was provided. Several paradoxes associated with secrecy, health-care settings, and the layering of stigma emerged in the reported experiences.

Obesity, stigma and public health planning.

Given the rise in obesity rates in North America, concerns about obesity-related costs to the health care system are being stressed in both the popular media and the scientific literature. With such constant calls to action, care must be taken not to increase stigmatization of obese people, particularly of children. While there is much written about stigma and how it is exacerbated, there are few guidelines for public health managers and practitioners who are attempting to design and implement obesity prevention programs that minimize stigma. We examine stigmatization of obese people and the consequences of this social process, and discuss how stigma is manifest in health service provision. We give suggestions for designing non-stigmatizing obesity prevention public health programs. Implications for practice and policy are discussed.

Culturally Competent Service Provision Issues Experienced By Aboriginal People Living With HIV/AIDS.

Cultural identity is an important factor in how well Aboriginal people respond to HIV/AIDS prevention or, once diagnosed with HIV or AIDS, how it affects their health care. This study explores the cultural skills among service providers who see Aboriginal people living with HIV/AIDS (APHAs) and the perspectives of APHAs. The purpose is to better understand the wellness needs of APHAs and how culturally competent care affects health service access and use. Data collection included face-to-face semi-structured interviews with APHAs and focus groups/interviews with community-based and primary health professionals in five regions of Canada. Interviews and focus groups were voice-recorded, verbatim transcribed, and coded using Atlas.ti(®) software. Thirty-five APHAs and fifty-two service providers were reached. Two key themes were noticed:Active addictions are a major obstacle to adherence to HIV drug regimes. Half of APHA participants said addictions are a major factor. A similar portion noted intensified substance use was an initial coping strategy when diagnosed. A slightly smaller portion noted that addictions were dealt with soon after diagnosis in order to begin antiretroviral treatment. Service providers who inform, encourage, and support APHAs' choices are viewed as "culturally competent."Addictions and HIV must be "treated together," reflecting a holistic worldview of Aboriginal people. Programs that integrate addiction treatment with HIV/AIDS and service providers who encourage and support APHA's choices are viewed as "wise practice" models by both sets of study participants offering some convergence and a set of five wise practices are identified.

Complexity and team dynamics in multiple intervention programmes: challenges and insights for public health psychology.

Psychologists engaged in public health research and intervention will become more involved in multiple intervention programming approaches. Managing innovation and complexity is a challenge when the team members come from different disciplines, organizational cultures and research perspectives. This report captures some of those challenges with a participatory, capacity-building, community-based intervention over research stages. We detail successful and less successful attempts to manage the challenges within changing public health contexts and end with concrete suggestions for teams with mixed intervention and research goals. Insights from this project should inform similar programmes with multi-level, participatory, community-based approaches.

Improving accuracy of transcripts in qualitative research.

Everyone who has worked with qualitative interview data has run into problems with transcription error, even if they do the transcribing themselves. A thoughtful, accurate, reliable, multilingual transcriptionist with a quick turnaround time is worth her or his weight in gold. In this article, the authors examine some transcription circumstances that seem to bring about their own consistent set of problems. Based on their experiences, the authors examine the following issues: use of voice recognition systems; notation choices; processing and active listening versus touch typing; transcriptionist effect; emotionally loaded audiotaped material; class and/or cultural differences among interviewee, interviewer, and transcriptionist; and some errors that arise when working in a second language. The authors offer suggestions for working with transcriptionists as part of the qualitative research team.

Immigrant women implementing participatory research in health promotion.

Few studies on women's health include immigrant women as participants, and fewer are conducted by immigrant women themselves. In this article, the authors present a model that allowed their full participation as researchers and authors. They describe their experiences using participatory research methods with Hispanic women in multiple ways to reach out to isolated women, collect data about community needs, and provide health education. They explore the advantages and challenges of being trained for both researcher and health educator roles, describe opportunities to use this approach to assess service needs, and discuss the potential for personal empowerment. They also report on the time commitment that such a bilingual project requires. In the process of interviewing marginalized women, they realized how much health promotion and participatory research complement each other. The authors conclude that combining participatory research with health promotion activities has promise to contribute toward increased empowerment of immigrant communities.