Stigmas experienced by sexual and gender minority people with HIV in the Dominican Republic: a qualitative study.

Background: As part of a study to test the feasibility and acceptability of the Finding Respect and Ending Stigma around HIV (FRESH) intervention to reduce stigmas and improve HIV viral suppression, our team collected qualitative data from men who have sex with men (MSM) with HIV, transgender women with HIV, and HIV healthcare providers for their perspectives on different stigmas in Dominican Republic healthcare settings.

Purpose: We aimed to develop an understanding of the causes, consequences, and domains of stigma among sexual and gender minorities with HIV in Dominican Republic HIV clinics.

Methods: Data collection occurred in Santo Domingo and Santiago (2020-2021) and included four focus groups with MSM with HIV (n = 26), in-depth interviews with transgender women with HIV (n = 14), and in-depth interviews with HIV healthcare providers (n = 16).

Puerto Rican physician's recommendations to mitigate medical migration from Puerto Rico to the mainland United States.

Puerto Rico (PR) is a United States (US) territory with a history of colonial violence, poverty, and government corruption. Due to these sociopolitical factors and natural disasters (e.g.

HIV and intersectional stigma among people living with HIV and healthcare workers and antiretroviral therapy adherence in the Dominican Republic.

Background: HIV-related stigma, discrimination, and social marginalization undermines optimal HIV care outcomes. More research examining the impact of HIV-related stigma, discrimination, other interlocking forms of oppression, and antiretroviral therapy (ART) adherence is needed to optimize HIV treatment programming. This study uses data from two clinics in the Dominican Republic to examine client and healthcare worker (HCW) perceptions of HIV and intersectional stigmas among people living with HIV.

"They think we wear loincloths": Spatial stigma, coloniality, and physician migration in Puerto Rico.

Puerto Rico (PR) is facing an unprecedented healthcare crisis due to accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing healthcare and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, our study analyzes the effects of spatial stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on 50 semi-structured interviews with physicians throughout PR and the US, we identified how stigmatizing meanings are attached to PR, its people, and its biomedical system, often incorporating colonial notions of the island's presumed backwardness, lagging medical technology, and lack of cutting-edge career opportunities.

On leaving: Coloniality and physician migration in Puerto Rico.

Puerto Rico (PR) has a growing physician migration problem. As of 2009, the medical workforce was composed of 14,500 physicians and by 2020 the number had been reduced to 9,000. If this migration pattern continues, the Island will not be able to meet the recommended physicians per capita ratio proposed by the World Health Organization (WHO).

Multilevel barriers to using assistive technology devices among older hispanics from poor and disadvantaged communities: the relevance of a gender analysis.

Purpose: To get a rich description of the barriers to using assistive technology (AT) among men and women ≥65 years living in poor and disadvantaged communities in Puerto Rico, an issue not well described among older people.

Methods: We conducted qualitative interviews assisted by videos of AT and guided by the Matching Person and Technology Model and the Gender Analysis Framework with a purposive sample of 23 men and women. Participants were asked questions regarding reasons for not using AT, willingness for using AT, their identified gender roles and gender-related activities, and bargaining positions.

Red tape, slow emergency, and chronic disease management in post-María Puerto Rico.

This paper draws upon the notion of as a framework to interpret ethnographic and qualitative findings on the challenges faced by Puerto Ricans with chronic conditions and health sector representatives throughout the island during and after Hurricane María. We conducted participant observation and qualitative interviews with chronic disease patients (n=20) health care providers and administrators (n=42), and policy makers (n=5) from across the island of Puerto Rico in 2018 and 2019. Many Puerto Ricans coping with chronic diseases during and after María experienced bureaucratic red tape as the manifestation of colonial legacies of disaster management and health care.

Adapting and pilot testing an HIV and intersectional stigma reducing intervention for Dominican Republic healthcare contexts: Protocol for translational research.

Background: This protocol details the adaptation and pilot testing of the Finding Respect and Ending Stigma around HIV (FRESH) intervention in Dominican Republic. FRESH is a healthcare setting stigma-reduction intervention designed to reduce stigmas affecting people living with HIV (PLHIV), focusing on HIV and intersectional stigmas experienced by sexual and gender minority (SGM) people living with HIV. After the successful adaptation of the FRESH intervention, it will be pilot-tested through the conduct of a pilot stepped wedge cluster randomized controlled trial.

The impact of Hurricane Maria on Puerto Rico's health system: post-disaster perceptions and experiences of health care providers and administrators.

Background: After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms. This article addresses how health care professionals and administrators experienced the health care system's collapse and the strategies used by them to meet their communities' health needs.

Methods: Data were collected between September 2018 and February 2020.

Sex disparities in the prevalence of physical function disabilities: a population-based study in a low-income community.

Background: Functional disability continues to be a significant public health problem that increases older adults' vulnerability to experience a diminished quality of life, loss of independence, higher healthcare costs and health services utilization, and increased risks of mortality. Thus, we aimed to study the prevalence of functional disabilities by sex according to the types of daily living activities, controlling for specific sociodemographic variables among older Hispanics from low-income communities.

Methods: We used a cross-sectional epidemiological research design, considering a complex sampling design of households to interview adults ≥65 years living in low-income communities in Puerto Rico.

Development and Validation of the Community PrEP-Related Stigma Scale (Community-PSS).

Despite increasing availability of pre-exposure prophylaxis (PrEP), HIV prevention efforts have stalled. It is important to study potential barriers to HIV prevention methods, such as pre-exposure prophylaxis stigma. This study aims to develop and validate the Community PrEP-related Stigma Scale (Community-PSS) to address gaps in the literature.

Understanding the Multilevel Disability Self-Management Strategies of Puerto Rican Older Men.

Aims: To explore the person, environment, and occupation-related self-management strategies used by older Hispanic men to cope with disabilities in different types of daily activities.

Methods: A concurrent transformative mixed method design (with priority given to the qualitative phase) guided by the Environment and Occupational Performance Model was used to collect and analyze data of 12 participants with functional disabilities. Quantitative data was gathered using the PROMIS Physical Function Short Form-20.

Stigmatizing Experiences of Trans Men in Puerto Rico: Implications for Health.

The past decade has seen an increase in efforts aimed at understanding the health needs of the transgender population. In the context of Puerto Rico (PR), those efforts have primarily focused on trans women due to their high human immunodeficiency virus (HIV) incidence. However, due to the low impact of the HIV epidemic among trans men, this remains an understudied population in PR.

Health Care-Specific Enacted HIV-Related Stigma's Association with Antiretroviral Therapy Adherence and Viral Suppression Among People Living with HIV in Florida.

Among people living with HIV (PLWH) in Florida, <2/3 are virally suppressed (viral load <200 copies/mL). Previous theoretical frameworks have pointed to HIV-related stigma as an important factor for viral suppression; an important outcome related to the HIV continuum of care. This study aims to analyze the association between enacted HIV-related stigma and antiretroviral therapy (ART) adherence and viral suppression among a sample of PLWH in Florida.

Enacted HIV-Related Stigma's Association with Anxiety & Depression Among People Living with HIV (PLWH) in Florida.

Research has shown that HIV-related stigma contributes to people living with HIV having a higher risk of mental health disorders. Our study examines the association between enacted HIV-related stigma and symptoms of anxiety and depression among PLWH. We used baseline data from 932 PLWH collected from the Florida Cohort study between 2014 and 2018.

EXPERIENCIAS Y PROCESO DE DUELO ENTRE PROFESIONALES DE ENFERMERÍA ONCOLÓGICA PEDIÁTRICA: EXPERIENCES AND GRIEVING PROCESS AMONG PEDIATRIC CANCER NURSES.

Explore how nursing professionals handle the death of a pediatric patient with cancer under their care and identify needs that they face in the workplace. An exploratory qualitative design was used, under the phenomenological framework and the Model of Information, Motivation and Behavioral Skills (IMHB). The data was obtained through semi-structured interviews with a sample of ten pediatric oncology nursing professionals.

Decolonial visual resistance as a public health strategy in post-María Puerto Rico.

In this article, we explore the use of the image as a strategy to understand how natural disasters and coloniality impact the health of marginalized communities. We focus on the aftermath of Hurricane María in Puerto Rico and aim to describe how local people used the image as a strategy to challenge the invisibility fostered by coloniality and advocate for a more humane, equitable and effective public health response. We implemented a mixed methods research design including: (1) ethnographic observations, (2) qualitative in-depth interviews with 67 representatives of the health care system, (3) photographs they had taken as part of their experiences during and after the hurricane and (4) images from local newspapers and social media.

"That's all Fake": Health professionals stigma and physical healthcare of people living with Serious Mental Illness.

Background: People living with a Serious Mental Illness (SMI) die earlier than the general population due to preventable medical conditions. Latinos living with SMI are a particularly vulnerable population with higher prevalence of chronic medical conditions. Stigma has been identified as a factor that fosters health inequities for Latinos/as with SMI, particularly Puerto Ricans.

An institutional ethnography of prevention and treatment services for substance use disorders in the Dominican Republic.

The Dominican Republic is thought to have significant epidemics of illicit drug use but lacks surveillance and formal analyses of the policy context of drug prevention and treatment services. We conducted an institutional ethnography of 15 drug service organisations in Santo Domingo and Boca Chica, Dominican Republic, to explore barriers and resources for drug abuse prevention and treatment. Here, we present a typology of drug service organisations based on their services, methods, and approach.

"Just Like Any Other Patient": Transgender Stigma among Physicians in Puerto Rico.

Background: Transgender women (TW) in Puerto Rico (PR) face social stigmatization. Physicians' transgender stigma can have detrimental consequences for TW's health.

Purpose: The objective of this study was to document physicians' knowledge, competencies, and attitudes towards TW in PR and study their associations with stigma towards TW.

HIV/AIDS stigma manifestations during clinical interactions with MSM in Puerto Rico.

HIV/AIDS stigma can have detrimental effects on physician/patient interactions when manifested by health professionals. Unfortunately, HIV/AIDS stigma is usually manifested in an intersectional manner with other pre-existing stigmas, including stigma towards men who have sex with men (MSM). Therefore, our study aimed to xamine the behavioral manifestations of HIV/AIDS stigma among physicians in training during simulated clinical interactions with MSM, and explore the interrelation between HIV/AIDS stigma attitudes and behaviors.

Introduction to the special issue: Applying a Caribbean perspective to an analysis of HIV/AIDS.

This introduction presents a special issue of with a collection of articles that offer multidisciplinary perspectives on HIV/AIDS in the Caribbean. Since the 1990s, poverty, marginalisation, and social stigma have been strong foci of much social science research on HIV/AIDS in the region. These three interrelated phenomena have been offered as explanatory factors contributing to the high prevalence of cases observed in this region.

An ethnographic study of 'touristic escapism' and health vulnerability among Dominican male tourism workers.

Health research on tourism has expanded over the past two decades, focusing on understanding how the social, economic, and political configuration of tourism zones might contribute to health vulnerabilities among the diverse populations that interact in these areas. While there are few studies of HIV and drug use interactions in the region, research has indicated that these two outcomes are often interwoven in tourism zones, potentially producing 'syndemics' of HIV infection and problematic drug use. One framework that has been used in public health research on tourism is one that we refer to as touristic escapism or situational disinhibition that may be heightened for some tourists while on vacation, potentially leading to the abandonment of normative constraints on behaviour and contributing to health risks such as unprotected sex or binge drinking.