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Health Disparity and Structural Violence: How Fear Undermines Health Among Immigrants at Risk for Diabetes

J Health Dispar Res Pract. 2013; 6(2): 30–47.

Published online 2013.

Janet Page-Reeves ¹, Joshua Niforatos, Shiraz Mishra, Lidia Regino, Andrew Gingrich, Robert Bulten

Abstract

Diabetes is a national health problem, and the burden of the disease and its consequences particularly affect Hispanics. While social determinants of health models have improved our conceptualization of how certain contexts and environments influence an individual's ability to make healthy choices, a structural violence framework transcends traditional uni-dimensional analysis. Thus, a structural violence approach is capable of revealing dynamics of social practices that operate across multiple dimensions of people's lives in ways that may not immediately appear related to health. Working with a Hispanic immigrant community in Albuquerque, New Mexico, we demonstrate how structural forces simultaneously directly inhibit access to appropriate healthcare services and create fear among immigrants, acting to further undermine health and nurture disparity. Although fear is not normally directly associated with diabetes health outcomes, in the community where we conducted this study participant narratives discussed fear and health as interconnected.

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Sexual Risk Behaviors, HIV Prevalence and Access to Reproductive Health Services Among Young Women Migrant Workers in the Industrial Zones in Vietnam

December 2021, Frontiers in Reproductive Health 3, DOI:10.3389/frph.2021.775375

Toan Ha

Stephen L. Schensul

Jean Schensul

Trang Nguyễn

Nam Nguyen

Background: Young migrant workers working in the industrial zones (IZ) in low and middle-income countries are at risk for HIV and other sexually transmitted diseases. This study examines the sex-related risks of young women migrant workers in the IZ in Vietnam. Materials and Methods: This cross-sectional survey was conducted among 1,061 young migrant women working in the IZ park in Hanoi, Vietnam. Multivariate logistic regression analysis was used to identify factors associated with HIV testing and condom use at last sex. Results: A total of 1,061 young women migrant workers completed the survey in which 652 participants consented to take the initial rapid HIV test. All but one participant tested negative indicating a HIV prevalence of 150 (95% CI: 27–860) per 100,000 population among this population. There were no differences in sexual behavior, use of sexual and reproductive health services, HIV knowledge, perceived HIV risk or alcohol use between those who were HIV tested and those not tested. Single participants reported high rates of first sex while living in the IZ and high rates of condom use during the first-time sex, however, they had low levels of condom use at last sex. While the majority of married participants used the SRH/HIV services, nearly 80% of the single participants who reported having sex never used SRH/HIV services since living in the IZ. However, single participants were over 4 times more likely to use condoms at last sex compared to married participants (OR = 4.67; 95%CI = 2.96–7.85). Participants with vocational school or higher education was more likely to use condom (OR = 2.19; 95%CI = 1.05–4.57). Neither HIV knowledge or alcohol use were associated with condom use. Conclusions: Although HIV prevalence is very low among young women workers in the IZ in Vietnam, a significant number of them engaged in risky sexual behavior and low levels of condom use at last sex as well as low level of using SRH/HIV services highlights a need to develop interventions that provide tailored-made and cultural appropriate SRH education for unmarried female migrant workers to prevent risky sexual behaviors, sexually transmitted diseases and unwanted pregnancy.

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Use Ecology and Drug Use Motivations of Methamphetamine Users Admitted to Substance Abuse Treatment Facilities in Los Angeles: An Emerging Profile

Journal of Addictive Diseases Volume: 21 Issue: 1 Dated: 2002 P: 45-60

Christina von Mayrhauser Ph.D.; Mary-Lynn Brecht Ph.D.; M. Douglass Anglin Ph.D.

2002This study was based on a longitudinal cohort design commonly used in substance abuse research for the collection of "natural history" data. The study was designed to provide a retrospective account of drug use and treatment effects by using subjects as their own controls for changes over time; thus, the study was quasi-experimental and did not have a matched control group for comparison purposes. The longitudinal cohort design maximized external validity by targeting one cohort of clients in several Los Angeles County substance abuse facilities in 1996. Use ecology data included MA varieties and street names, first introductions to use, drug-use histories, access, selling and manufacturing, routes of administration, unwanted results of use, and participants' use behavior in the year before the 1996 treatment. Information on motivation for using MA indicates that clients used MA as a substitute for other stimulants; to cope with mental distress; to stay awake; to enhance sexual experience; and to lose weight. Two case studies are presented to provide a more holistic portrait of clients who are struggling with MA abuse, so as to present two motivation categories (cope with mental distress and as a sexual stimulant) that present special challenges for treatment intake counselors.

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Understanding Racial Inequities in the Implementation of Harm Reduction Initiatives Andrea M.Lopez, PhD, Matthew Thomann, PhD, ZenaDhatt, BS, Julieta Ferrera, MAA, Marwa Al-Nassir, MPH, Margaret Ambrose, BA, and Shane Sullivan, BA

Objectives: To elucidate a structurally oriented theoretical framework that considers legacies of racism, trauma, and social exclusion and to interrogate the “unmet obligations” of the institutionalization of the harm reduction infrastructure to provide equitable protections to Black and Latinx people who use drugs(PWUD) in Maryland.

Methods: In 2019, we conducted a rapid ethnographic assessment and qualitative interviews with PWUD(n=572) and stakeholders (n=585) in 5 Maryland counties. We assessed PWUD’s experiences, service gaps in as well as barriers and facilitators to accessing services, and the potential to expand harm reduction programs.

Results: he unmet obligations we found included enforcement and punitive governance of syringes, naloxone, and other drug use equipment; racism and racialization, social exclusion, and legacies of trauma; and differential implications of harm reduction for populations experiencing racialized criminalization.

Conclusions: The implementation of harm reduction policies are a first step, but assessment of structural dynamics are needed for diverse communities with unique histories. This research illuminates a key paradox: progressive policy is implemented, yet the overdose crisis escalates in communities where various forms of racialized exclusions are firmly entrenched. (AmJPublicHealth.2022;112(S2):S173–S181. https://doi.org/10.2105/AJPH.2022.306767)

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Health Disparities and Health Omissions: Pushing Medical Anthropology Forward in the United States

Chelsey R. Carter

January 24, 2022, https://doi.org/10.1002/nad.12153

Racialized diagnosis of the fatal neurodegenerative disease ALS illustrates the limitations of medical anthropological knowledge that focuses only on “ethnic differences” to explain health disparities at the population level. I argue that a central focus on racism in our analysis of biomedical US spaces, and explicitly anti-Black racism, will better equip anthropologists to understand how racialized forms of knowledge production in medicine and science have deleterious effects on people’s lives and bodies. The aggregate effects of racial science (the belief that human beings can be separated into biologically distinct groups) in slavery’s afterlife impact how clinicians and researchers see and treat Black people. I elaborate the concept of “health omissions” to equip anthropologists, clinical researchers, and biomedical clinicians with an analytical and truth-telling lens that can attend to the ways that systemic marginalization in slavery’s afterlife omits Black people’s health problems and care.