1,720,999 research outputs found
Disentangling the stigma of HIV/AIDS from the stigmas of drugs use, commercial sex and commercial blood donation – A factorial survey of medical students in China
Full text linkBackground: HIV/AIDS related stigma interferes with the provision of appropriate care and
support for people living with HIV/AIDS. Currently, programs to address the stigma approach it as
if it occurs in isolation, separate from the co-stigmas related to the various modes of disease
transmission including injection drug use (IDU) and commercial sex (CS). In order to develop
better programs to address HIV/AIDS related stigma, the inter-relationship (or 'layering') between
HIV/AIDS stigma and the co-stigmas needs to be better understood. This paper describes an
experimental study for disentangling the layering of HIV/AIDS related stigmas.
Methods: The study used a factorial survey design. 352 medical students from Guangzhou were
presented with four random vignettes each describing a hypothetical male. The vignettes were
identical except for the presence of a disease diagnosis (AIDS, leukaemia, or no disease) and a cocharacteristic
(IDU, CS, commercial blood donation (CBD), blood transfusion or no cocharacteristic).
After reading each vignette, participants completed a measure of social distance that
assessed the level of stigmatising attitudes.
Results: Bivariate and multivariable analyses revealed statistically significant levels of stigma associated with AIDS, IDU, CS and CBD. The layering of stigma was explored using a recently
developed technique. Strong interactions between the stigmas of AIDS and the co-characteristics
were also found. AIDS was significantly less stigmatising than IDU or CS. Critically, the stigma of
AIDS in combination with either the stigmas of IDU or CS was significantly less than the stigma of
IDU alone or CS alone.
Conclusion: The findings pose several surprising challenges to conventional beliefs about HIV/
AIDS related stigma and stigma interventions that have focused exclusively on the disease stigma.
Contrary to the belief that having a co-stigma would add to the intensity of stigma attached to
people with HIV/AIDS, the findings indicate the presence of an illness might have a moderating
effect on the stigma of certain co-characteristics like IDU. The strong interdependence between
the stigmas of HIV/AIDS and the co-stigmas of IDU and CS suggest that reducing the co-stigmas
should be an integral part of HIV/AIDS stigma intervention within this context
Structure, (governance) and health: An unsolicited response
Full text linkBackground: In a recently published article, it was suggested that governance was the significant
structural factor affecting the epidemiology of HIV. This suggestion was made notwithstanding the
observed weak correlation between governance and HIV prevalence (r = .2). Unfortunately, the
paper raised but left unexamined the potentially more important questions about the relationship
between the broader health of populations and structural factors such as the national economy and
physical infrastructure.
Methods: Utilizing substantially the same data sources as the original article, the relationship
between population health (healthy life expectancy) and three structural factors (access to
improved water, GDP per capita, and governance) were examined in each of 176 countries.
Results: Governance was found to be significantly correlated with population health, as were GDP
per capita, and access to improved water. They were also found to be significantly correlated with
each other.
Conclusion: The findings are discussed with reference to the growing interest in structural factors
as an explanation for population health outcomes, and the relatively weak relationship between
governance and HIV prevalence
Measuring global health inequity
Full text linkBackground: Notions of equity are fundamental to, and drive much of the current thinking about
global health. Health inequity, however, is usually measured using health inequality as a proxy –
implicitly conflating equity and equality. Unfortunately measures of global health inequality do not
take account of the health inequity associated with the additional, and unfair, encumbrances that
poor health status confers on economically deprived populations.
Method: Using global health data from the World Health Organization's 14 mortality sub-regions,
a measure of global health inequality (based on a decomposition of the Pietra Ratio) is contrasted
with a new measure of global health inequity. The inequity measure weights the inequality data by
regional economic capacity (GNP per capita).
Results: The least healthy global sub-region is shown to be around four times worse off under a
health inequity analysis than would be revealed under a straight health inequality analysis. In
contrast the healthiest sub-region is shown to be about four times better off. The inequity of poor
health experienced by poorer regions around the world is significantly worse than a simple analysis
of health inequality reveals.
Conclusion: By measuring the inequity and not simply the inequality, the magnitude of the
disparity can be factored into future economic and health policy decision making
Stigma, social reciprocity and exclusion of HIV/AIDS patients with illicit drug histories: A study of Thai nurses' attitudes
Full text linkBackground: Stigma is a key barrier for the delivery of care to patients living with HIV/AIDS
(PLWHA). In the Asia region, the HIV/AIDS epidemic has disproportionately affected socially
marginalised groups, in particular, injecting drug users. The effect of the stigmatising attitudes
towards injecting drug users on perceptions of PLWHA within the health care contexts has not
been thoroughly explored, and typically neglected in terms of stigma intervention.
Methods: Semi-structured interviews were conducted with a group of twenty Thai trainee and
qualified nurses. Drawing upon the idea of 'social reciprocity', this paper examines the
constructions of injecting drug users and PLWHA by a group of Thai nurses. Narratives were
explored with a focus on how participants' views concerning the high-risk behaviour of injecting
drug use might influence their attitudes towards PLWHA.
Results: The analysis shows that active efforts were made by participants to separate their views
of patients living with HIV/AIDS from injecting drug users. While the former were depicted as
patients worthy of social support and inclusion, the latter were excluded on the basis that they
were perceived as irresponsible 'social cheaters' who pose severe social and economic harm to the
community. Absent in the narratives were references to wider socio-political and epidemiological
factors related to drug use and needle sharing that expose injecting drug users to risk; these
behaviours were constructed as individual choices, allowing HIV positive drug users to be blamed
for their seropositive status. These attitudes could potentially have indirect negative implications
on the nurses' opinions of patients living with HIV/AIDS more generally.
Conclusion: Decreasing the stigma associated with illicit drugs might play crucial role in improving
attitudes towards patients living with HIV/AIDS. Providing health workers with a broader
understanding of risk behaviours and redirecting government injecting drug policy to harm
reduction are discussed as some of the ways for stigma intervention to move forward
HIV, Stigma, and Rates of Infection: A Rumour without Evidence
Full text linkThe modern concept of a social stigma comes from the work of American sociologist Erving Goffman, who described it as a response to a deeply discrediting attribute that devalues the person [1]. In the medical literature, stigma is almost inevitably written about in terms of adverse social sequelae of a disease—such as leprosy, tuberculosis, epilepsy, schizophrenia, or filariasis [2–6]—or a physical characteristic or functional loss, such as obesity, deafness, or paraplegia [7–9]. The consequences of stigma range from moderate opprobrium at one end of the spectrum to death [10]
Governance and health systems performance: Exploring the association and pathways
No full textThis thesis was submitted for the degree of Doctor of Public Health and awarded by Brunel University.There has been an increase in empirical evidence indicating an association between
governance and health systems, suggesting that better governed countries tend to have healthier populations with better performing health systems. This is an important finding, as it could point to structural public health interventions having a greater impact on health systems performance than individually targeted interventions. This doctoral thesis in public health (DrPH) from Brunel University is a compilation of three independent research projects undertaken under different settings, converging in the examination of the relationship between governance and health systems. The first project was a study conducted in the African region of the World Health Organization with the aim of understanding how and to what extent measures of governance are statistically correlated with performance of health systems as measured by a key health outcome: the under-five child mortality. The second project was a case study from a high income country in Europe during the period in
which it went through an economic meltdown, the focus being a qualitative analysis of the extent to which the response to economic crisis influenced public health policy making and short term performance of the health system. The third project was a policy analysis carried out in an upper middle income country in Asia and the focus
was to examine how the long history of health financing reform has influenced the
performance of the health system. All research projects indicate an association between governance and health systems and the case studies provide empirical evidence of how health systems are affected by governance quality. The African study shows a statistically positive relationship between governance indicators and health outcomes, suggesting better governed countries to have lower child mortality. The European and the Asian cases suggest accountability, responsiveness, transparency and fair partnership to be important governance qualities for successful policy making and reforms. This evidence could be of use to current and future policy makers and others with the authority to configure and implement new public health policies. It indicates the importance of comprehensive analytical work prior to policy making with easy access to documents and fair participation with all stakeholders to increase the probability of reaching consensus oriented policy proposals followed by successful implementations. The main contribution of this thesis is to provide evidence through robust statistical/ qualitative analysis around the association between governance and health systems in countries at all income levels. The originality is located in the breadth (three different settings) as well as depth (three distinct, robust methods) of this kind of research. The congruence of findings regardless of study locations, the outcome measures used or types of methods applied have added to the growing evidence that there is a strong correlation between governance and health systems performance. This increased knowledge provides policy makers with additional evidence which can be applied to develop and improve governance with the aim of allocating public resources more efficiently and equitably. However, further research is required on governance and its link to health systems, inter alia how health equity is affected by selective partnership in the decision making processes and how political ideologies influence governance practices
Detecting and preventing financial abuse of older adults: Examining decision making by health, social care and banking professionals
No full textThis thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Financial elder abuse is gaining increasing attention from researchers and policy makers. Such abuse can include theft of money as well as misuse of assets such as property. This research applied judgement analysis methodology to explore professional decision making in the context of such abuse and to identify the nature of the cues used to detect and prevent abuse. Participants included social care, health and banking professionals, who were established as key decision makers. In Phase I, semi-structured interviews (n = 63) were conducted. The critical incident technique was used to identify cue use and decisions taken in the most recent case experienced. Key cues for both social care and health professionals included the nature of the ‘financial problem suspected’, the older persons ‘mental capacity’ and the ‘identifier of the abuse’, this being whether the abuse was directly observed or instead reported by a third party. A separate cue used by health professionals was the individual’s ‘physical capacity’. Banking professionals did not use physical or mental capacity as cues, but independently considered ‘who was in charge of the money’. Decisions made by social care professionals included determining whether safeguarding procedures should be
implemented. In Phase II, a factorial survey approach was applied whereby social care, health and banking professionals (n=223) were presented with case scenarios incorporating the cues from Phase I in addition to cues from literature review. Multiple regression analysis and incremental F-tests identified the cues that explained a significant amount of the variance in judgements of certainty of abuse and likelihood of taking action. For example, for social care and health professionals this included the older person’s mental capacity, and the nature of the financial problem suspected. The findings could be used to develop a training tool to enable other professionals to improve their strategies for detection and prevention of financial elder abuse.ESRC (Reference Number: RES-352-25-0026
Social sciences research in neglected tropical diseases 3: Investment in social science research in neglected diseases of poverty: a case study of Bill and Melinda Gates Foundation
Full text linkThis article has been made available through the Brunel Open Access Publishing Fund.BACKGROUND: The level of funding provides a good proxy for the level of commitment or prioritisation given to a particular issue. While the need for research relevant to social, economic, cultural and behavioural aspects of neglected tropical diseases (NTD) control has been acknowledged, there is limited data on the level of funding that supports NTD social science research.
METHOD: A case study was carried out in which the spending of a major independent funder, the Bill and Melinda Gates Foundation (BMGF) - was analysed. A total of 67 projects funded between October 1998 and November 2008 were identified from the BMGF database. With the help of keywords within the titles of 67 grantees, they were categorised as social science or non-social science research based on available definition of social science. A descriptive analysis was conducted.
RESULTS: Of 67 projects analysed, 26 projects (39%) were social science related while 41 projects (61%) were basic science or other translational research including drug development. A total of US 241 million) went to social science research. Although the level of funding for social science research has generally been lower than that for non-social science research over 10 year period, social science research attracted more funding in 2004 and 2008.
CONCLUSION: The evidence presented in this case study indicates that funding on NTD social science research compared to basic and translational research is not as low as it is perceived to be. However, as there is the acute need for improved delivery and utilisation of current NTD drugs/technologies, informed by research from social science approaches, funding priorities need to reflect the need to invest significantly more in NTD social science research
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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