Empatía, agresividad y perdón en contextos de vulnerabilidad, hostilidad y seguridad en niños y adolescentes

Introducción: El objetivo de este artículo fue identificar las variables que mejor predicen las medidas de agresión, empatía y perdón, como también las principales diferencias en contextos vulnerables, hostiles y seguros, en una muestra de niños, niñas y adolescentes pertenecientes a una población vulnerable. Método: se realizó un estudio cuantitativo transversal con una muestra no probabilística incidental de 85 participantes, se emplearon medidas psicométricas para la empatía, agresión y perdón. Los participantes fueron convocados en una fundación de atención a víctimas para realizar una entrevista y aplicar el test. Resultados: Se encontraron efectos estadísticamente significativos entre las variables del modelo verificado, donde la empatía predice la agresión en el contexto hostil, pero no en el vulnerable y seguro. A su vez, la empatía predice el perdón en los contextos vulnerables y seguros, y la agresión predice el perdón en el modelo hostil, pero no es significativo su efecto en el contexto vulnerable y seguro. Además, la empatía tiene un papel clave en la comprensión del perdón, dado que se asocia a conductas agresivas en los contextos de hostilidad, mientras que un modelo de perdón debería ser diferencial en estos contextos. Conclusiones: Los hallazgos de este estudio brindan evidencia empírica que sustenta la importancia de la implementación de estrategias para mejorar las habilidades relacionadas con la empatía en niños y adolescentes, desde la perspectiva de la educación para la paz y el perdón. Además, se demostró que los aspectos como el clima familiar, las vulnerabilidades de los contextos de riesgo y la misma cultura, pueden determinar el desarrollo de habilidades socioemocionales que favorecen el perdón, empatía y otras capacidades interpersonales.

Introduction: The aim of this study was to identify the variables that best predict measures of aggression, empathy, and forgiveness, as well as the main differences in vulnerable, hostile and safe contexts, in a sample of children and adolescents belonging to a vulnerable population. Method: A cross-sectional quantitative study was conducted with a non-probabilistic incidental sample of 85 participants. Psychometric measures of empathy, aggression, and forgiveness were used. The participants were invited to a victim assistance foundation for an interview and test application. Results: Statistically significant effects were found among the variables in the verified model, where empathy predicts aggression in the hostile context, but not in the vulnerable and safe context. In turn, empathy predicts forgiveness in the vulnerable and safe contexts, and aggression predicts forgiveness in the hostile model, but its effect in the vulnerable and safe context is not significant. Furthermore, empathy plays a key role in understanding forgiveness, given that it is associated with aggressive behaviors in the hostile contexts, whereas a forgiveness model should be differential in these contexts. Conclusions: The findings of this study provide empirical evidence that supports the importance of implementing strategies to improve empathy-related skills in children and adolescents, from the perspective of peace education and forgiveness. In addition, it was shown that aspects such as family climate, vulnerabilities of risk contexts and culture itself, can determine the development of socioemotional skills that favor forgiveness, empathy, and other interpersonal skills.

Engaging HIV-prevention ambassadors to promote oral PrEP among adolescent girls and young women: results of a Zimbabwe field test.

The HIV Prevention Ambassador Training Package for Adolescent Girls and Young Women was created in collaboration with adolescent girls and young women (AGYW) to improve skills, knowledge, and attitudes about oral pre-exposure prophylaxis (PrEP) among peer "ambassadors". It was field tested with 17 ambassadors in Mazowe District, Zimbabwe and changes in ambassadors' knowledge and attitudes about oral PrEP, as well as changes in oral PrEP uptake among AGYW in the district, were assessed. The training package improved oral PrEP knowledge among trained ambassadors and built AGYW's skills to advocate for oral PrEP awareness and rollout. Use of the training package correlated with a 59% increase in oral PrEP uptake among AGYW in Mazowe District in the seven months following the training. The ambassador training package could help support oral PrEP introduction and scale up in countries with high HIV incidence by engaging AGYW in oral PrEP rollout in their communities.

The health impacts of violence perpetrated by police, military and other public security forces on gay, bisexual and other men who have sex with men in El Salvador.

Gay, bisexual and other men who have sex with men face both high levels of violence and a disproportionate burden of poor health outcomes. We explored violence perpetrated against Salvadoran gay, bisexual and other men who have sex with men by public security forces; perceived motivations of violence; and impacts on health. We conducted structured qualitative interviews with 20 participants and used systematic coding and narrative analysis to identify emergent themes. Nearly all participants described the physical, emotional, sexual and/or economic violence by public security forces. Most attributed being targeted to their gender expression and/or perceived sexual orientation. The most common impact was emotional distress, including humiliation, fear and depression; lasting physical injuries were also widely reported. Study participants felt unable to report these incidents for fear of retribution or inaction. Men reported feelings of helplessness and distrust, avoidance of authorities and altering when, where or how often they appeared in public spaces. Programmes and interventions should focus on providing mental health services for LGBTI (lesbian, gay, bisexual, transgender and intersex) victims of violence, educating public security forces on the legal rights of Salvadorans and expanding current LGBTI-inclusive policies to all public security forces.

Assessing an inclusive model to increase access to comprehensive gender-based violence response services and improve HIV outcomes in Puerto Plata, Dominican Republic.

Experiences of gender-based violence (GBV) are associated with increased vulnerability to HIV and difficulty accessing HIV services; at the same time, people living with HIV are at an increased risk of GBV. Key populations most affected by HIV - gay and other men who have sex with men, female sex workers and transgender women - also experience a disproportionate burden of GBV. In Puerto Plata, Dominican Republic, a local civil society organisation has led efforts to improve and integrate GBV and HIV services while making them welcoming to key population members and people living with HIV. According to interviews with service providers and service users and an analysis of service statistics, the intervention improved service quality and coordination, increased disclosures of violence and increased GBV response service uptake among the general population, key population members and people living with HIV. Findings also suggest that the intervention increased the uptake of HIV services, including HIV testing and post-exposure prophylaxis, and improved mental health among those receiving GBV response services. This case study of integrated GBV and HIV services describes a new model for simultaneously, synergistically and inclusively addressing two major epidemics negatively affecting health and well-being in affected communities today.

"We're Going to Leave You for Last, Because of How You Are": Transgender Women's Experiences of Gender-Based Violence in Healthcare, Education, and Police Encounters in Latin America and the Caribbean.

Transgender (trans) women experience gender-based violence (GBV) throughout their lives, which impedes their access to services and contributes to poor health outcomes and quality of life. To inform policies and health programs, trans women worked with the United States Agency for International Development (USAID)- and President's Emergency Plan for AIDS Relief (PEPFAR)-supported LINKAGES project, the United Nations Development Programme, The University of the West Indies, and local organizations to document experiences of GBV and transphobia in healthcare, education, and police encounters. Trans women conducted 74 structured interviews with other trans women in El Salvador, Trinidad and Tobago, Barbados, and Haiti in 2016. We conducted qualitative applied thematic analysis to understand the nature and consequences of GBV and transphobia and descriptive quantitative analysis to identify the proportion who experienced GBV in each context. A high proportion experienced GBV in education (85.1%), healthcare (82.9%), from police (80.0%), and other state institutions (66.1%). Emotional abuse was the most common in all contexts and included gossiping, insults, and refusal to use their chosen name. Participants also experienced economic, physical, and sexual violence, and other human rights violations based on their gender identity and expression. At school, participants were physically threatened and assaulted, harassed in bathrooms, and denied education. In healthcare, participants were given lower priority and received substandard care. Healthcare workers and police blamed participants for their health and legal problems, and denied them services. From police, participants also experienced physical and sexual assault, theft, extortion for sex or money, and arbitrary arrest and detention. Participants had difficulty obtaining identification documents that matched their gender identity, sometimes being forced to alter their appearance or being denied an identification card. Service providers not only failed to meet the specific needs of trans women but also discriminated against them when they sought services, exacerbating their economic, health, and social vulnerability. Although international and regional resolutions call for the legal protection of transgender people, states do not meet these obligations. To respect, promote, and fulfill trans women's human rights, governments should enact and enforce antidiscrimination and gender-affirming laws and policies. Governments should also sensitize providers to deliver gender-affirming services.

Experiences of gender-based violence among female sex workers, men who have sex with men, and transgender women in Latin America and the Caribbean: a qualitative study to inform HIV programming.

BACKGROUND: Female sex workers, MSM, and transgender women-collectively referred to as key populations (KPs)-are disproportionately affected by gender-based violence (GBV) and HIV, yet little is known about the violence they face, its gender-based origins, and responses to GBV. The purpose of this study was to understand the nature and consequences of GBV experienced, to inform HIV policies and programming and to help protect KPs' human rights. METHODS: Using a participatory approach, FSWs, MSM, and transgender women in Barbados, El Salvador, Trinidad and Tobago, and Haiti conducted 278 structured interviews with peers to understand their experiences of and responses to GBV. Responses to open-ended questions were coded in NVivo and analyzed using an applied thematic analysis. RESULTS: Nearly all participants experienced some form of GBV. Emotional and economic GBV were the most commonly reported but approximately three-quarters of participants reported sexual and physical GBV and other human rights violations. The most common settings for GBV were at home, locations where sex work took place such as brothels, bars and on the street; public spaces such as parks, streets and public transport, health care centers, police stations and-for transgender women and MSM-religious settings and schools. The most common perpetrators of violence included: family, friends, peers and neighbors, strangers, intimate partners, sex work clients and other sex workers, health care workers, police, religious leaders and teachers. Consequences included emotional, physical, and sexual trauma; lack of access to legal, health, and other social services; and loss of income, employment, housing, and educational opportunities. Though many participants disclosed experiences of GBV to friends, colleagues and family, they rarely sought services following violence. Furthermore, less than a quarter of participants believed that GBV put them at risk of HIV. CONCLUSIONS: Our study found that across the four study countries, FSWs, MSM, and transgender women experienced GBV from state and non-state actors throughout their lives, and much of this violence was directly connected to rigid and harmful gender norms. Through coordinated interventions that address both HIV and GBV, this region has the opportunity to reduce the national burden of HIV while also promoting key populations' human rights.

Can a national government implement a violence prevention and response strategy for key populations in a criminalized setting? A case study from Kenya.

INTRODUCTION: Key population (KP) members frequently experience violence that violates their human rights, increases their risk of HIV, and acts as a barrier to access and uptake of HIV services. To be effective, HIV programmes for members of KPs need to prevent and respond to violence against them. We describe a violence prevention and response strategy led by the national KP programme in Kenya and examine trends in reports of and responses to violence (provision of support to an individual who reports violence within 24 hours of receiving the report). METHODS: Quarterly programme monitoring data on the number of reports of violence and the number of responses to violence from 81 implementing partners between October 2013 and September 2017 were aggregated annually and analysed using simple trend analysis. Reports of violence relative to KP members reached, expressed as a percentage, and the percentage of reports of violence that received a response were also examined. RESULTS AND DISCUSSION: Between 2013 and 2017, annual reports of violence increased from 4171 to 13,496 cases among female sex workers (FSWs), 910 to 1122 cases among men who have sex with men (MSM) and 121 to 873 cases among people who inject drugs (PWID). Reports of violence relative to KP members reached increased among FSWs (6.2% to 9.7%; p < 0.001) and PWID (2.1% to 6.0%; p < 0.001) and decreased among MSM (10.0% to 4.2%; p < 0.001). During the same period, timely responses to reports of violence increased from 53% to 84% (p < 0.001) among FSWs, 44% to 80% (p < 0.001) among MSM and 37% to 97% (p < 0.001) among PWID. CONCLUSIONS: Over the past four years in Kenya, there has been an increase in violence reporting among FSWs and PWID and an increase in violence response among all KPs. This case study demonstrates that violence against KP members can be effectively addressed under the leadership of the national government, even in an environment where KP members' behaviours are criminalized. Creating an enabling environment to promote wellbeing and safety for KP members is a critical enabler for HIV prevention programmes to achieve 95-95-95 goals.

Social Desirability Response Bias and Other Factors That May Influence Self-Reports of Substance Use and HIV Risk Behaviors: A Qualitative Study of Drug Users in Vietnam.

The accuracy of self-report data may be marred by a range of cognitive and motivational biases, including social desirability response bias. The current study used qualitative interviews to examine self-report response biases among participants in a large randomized clinical trial in Vietnam. A sample of study participants was reinterviewed. The vast majority reported being truthful and emphasized the importance of rapport with the study staff for achieving veridical data. However, some stated that rapport may lead to under reporting of risk behaviors in order not to disappoint study staff. Other factors that appeared to influence accuracy of self-reports include fear that the information may be divulged, desire to enroll in the study, length of the survey, and memory. There are several methods that can be employed to reduce response biases, and future studies should systematically address response bias and include methods to assess whether approaches and survey items are effective in improving accuracy of self-report data.

Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam.

BACKGROUND: Integration of methadone maintenance therapy (MMT) and HIV services is an evidence-based intervention (EBI) that benefits HIV care and reduces costs. While MMT/HIV integration is recommended by the World Health Organization and the Centers for Disease Control and Prevention, it is not widely implemented, due to organizational and operational barriers. Our study applied an innovative process to identify implementation strategies to address these barriers. METHODS: Our process was adapted from the Expert Recommendations for Implementing Change (ERIC) protocol and consisted of two main phases. In Phase 1, we conducted 16 in-depth interviews with stakeholders and developed matrices to display barriers to integration. In Phase 2, we selected implementation strategies that addressed the barriers identified in Phase 1 and conducted a poll to vote on the most important and feasible strategies among a panel with expertise in cultural context and implementation science. RESULTS: Barriers fell into two broad categories: policy and programmatic. At the policy level, barriers included lack of a national mandate, different structures (MMT vs. HIV clinic) for cost reimbursement and staff salaries, and resistance on the part of staff to take on additional tasks without compensation. Programmatic barriers included the need for cross-training in MMT and HIV tasks, staff accountability, and commitment from local leaders. In Phase 2, we focused on programmatic challenges. Based on voting results and iterative dialogue with our expert panel, we selected several implementation strategies in the domains of technical assistance, staff accountability, and local commitment that targeted these barriers. CONCLUSIONS: Key programmatic barriers to MMT/HIV integration in Vietnam may be addressed through implementation strategies that focus on technical assistance, staff accountability, and local commitment. Our process of identifying implementation strategies was simple, low cost, and potentially replicable to other settings.