The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related medical and support services for uninsured and underinsured people living with HIV (PLWH) in the United States. In addition to HIV-related medical care, the program provides medical nutrition therapy and food assistance. The role of nutrition in the health of PLWH is well-documented, especially in resource poor areas; however, the role of medical nutrition therapy and food assistance provided through the RWHAP in resource rich areas is not well documented. This study addressed the association between the nutrition services of food assistance and medical nutrition therapy and the HIV-related health outcomes of viral suppression, retention in care, and CD4 counts. The behavioral model for vulnerable populations was used as the theoretical foundation for this quantitative cross-sectional study. A sample of 428 RWHAP clients was used from the Ryan White Services Report data. Pearson's chi-square was used to examine the association between medical nutrition therapy (MNT) and viral suppression. Findings indicated statistically significant associations between MNT and viral suppression, retention in care and any nutrition service (food assistance, MNT, or both), and MNT and retention in care. Implications for social change include emphasizing the role of nutrition services in HIV-related health outcomes for PLWH in resource rich areas.

Since the war on drugs in the 1980s, the United States has seen an exponential rise in the number of imprisoned individuals. This increase has been particularly dramatic for women. Nationwide, the population of women in prison has grown by 834% over the past 40 years, more than double the growth rate of men. Compared with incarcerated men, women in prison have higher rates of substance abuse, histories of physical and sexual abuse, mental illness, infectious disease and chronic illness. Most women in prison are defined by a challenging intersection of lower socioeconomic status and largely racial, ethnic, and minority gender status. This combination of identity factors both contributes to their health disparities and influences their experiences with health care. Given that the majority of women in prison are of reproductive age, gynecological care is a central aspect of women’s overall health care. However, women in prison are a small minority of the overall incarcerated population, and because of this, their gender-specific health needs are frequently unacknowledged. Using a feminist epistemology, this qualitative multiple case study provides an examination of the experiences of women before prison and in prison with gynecological care and prison staff’s experiences providing this care. The Gelberg Andersen Behavioral Model for Vulnerable Populations is adapted here for the study of women in prison. The model explains factors enabling and impeding women’s utilization of health care services, including previous health care experiences, prison infrastructure, and personal autonomy. Women in contact with the criminal justice system face difficulties accessing health care both outside and inside prison. Barriers on the outside included lack of health insurance, being addicted to drugs, and prioritizing children’s needs first. On the inside women cited a lack of confidentiality, the absence of trust in providers, and the inability to participate in treatment decision-making. In the case of women in prison, multiple external oppressions result in internalized negative beliefs. Such feelings of powerlessness, lack of control, curtailed agency, and threatened self-worth ultimately influence how women experience gynecological care in prison. Policy, practice and research implications are provided to meet the gender specific health needs of women in prison.

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Thesis (Ph.D. in Nursing) -- University of Colorado at Denver and Health Sciences Center, 2006. / Typescript. Includes bibliographical references (leaves 188-199). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

Objective: Children Born of War (CBOW) are an international and timeless phenomenon that exists in every country involved in war or armed conflict. Nevertheless, little is known on a systematic level about those children, who are typically fathered by a foreign or enemy soldier and born to a local mother. In particular, the identity issues that CBOW often report have remained largely uninvestigated. In the current qualitative study we began filling this gap in the scientific literature by asking how CBOW construct their identity in self-descriptions. Method: We utilized thematic content analysis of N = 122 German CBOWs' answers to an open-ended questionnaire item asking how they see themselves and their identity in the context of being a CBOW. Results: We identified five key themes in CBOW' identity accounts. Loneliness and lack of belonging appeared as a paramount aspect of their self-descriptions next to narratives about belonging and positive relationship. On a less interpersonal basis, we found fighting and surviving and searching for truth and completion overarching aspects of their identities. There were also few accounts growing up unaffected by the fact of being born a CBOW. Although all themes portray different perspectives, they all (but the last one) clearly indicate the impeded circumstances under which CBOW had to grow up. Conclusions: Integrating our findings with existing interdisciplinary literature regarding identity, we discuss implications for future research and clinical and political practice.

Mitigation response plans must be created to protect affected populations during biological emergencies resulting from the release of harmful biochemical substances. Medical countermeasures have been stockpiled by the federal government for such emergencies. However, it is the responsibility of local governments to maintain solid, functional plans to apply these countermeasures to the entire target population within short, mandated time frames. Further, vulnerabilities in the population may serve as barriers preventing certain individuals from participating in mitigation activities. Therefore, functional response plans must be capable of reaching vulnerable populations.Transportation vulnerability results from lack of access to transportation. Transportation vulnerable populations located too far from mitigation resources are at-risk of not being able to participate in mitigation activities. Quantification of these populations requires the development of computational methods to integrate spatial demographic data and transportation resource data from disparate sources into the context of planned mitigation efforts. Research described in this dissertation focuses on quantifying transportation vulnerable populations and maximizing participation in response efforts. Algorithms developed as part of this research are integrated into a computational framework to promote a transition from research and development to deployment and use by biological emergency planners.

This study assessed the role of the International Organization for Migration (IOM) in HIV-prevention among mobile and vulnerable populations (MVPs) and potential emigrants in Beitbridge. A mixed-method approach, which combines quantitative and qualitative approaches, was used in this action research. A total of 20 in-depth face-toface interviews were conducted with key informants and 56 self-administered questionnaires were completed by MVPs and potential emigrants in Beitbridge. The study found that a number of effective strategies are currently being implemented as a preventative measure by the IOM within MVPs and potential emigrants’ communities in Beitbridge. At the same time, however, in order to ensure sustainability of these HIVprevention initiatives, the IOM must promote long-term synergies with other strategic partners throughout the project cycle. It is recommended that, the IOM strategically position itself by moving a step further from being the sole provider of emergency humanitarian support towards devising sustainable and durable solutions among MVPs and potential emigrants. / Sociology / M.A. (Social Behaviour Studies in HIV-AIDS)

This study is a secondary analysis of survey data collected in fall 2000 from patients of a safety-net hospital and its eight community health outreach clinics in Fort Worth, Texas. The study examined three objectives. These include explaining the utilization of Pap smear tests among the sample who were low-income women, by ascertaining the determinants of using these services. Using binary logistic regressions analyses primarily, the study tested 10 hypotheses. The main hypothesis tested the race/ethnicity/immigration status effect on Pap smear screening. The remaining hypotheses examined the effects of other independent/control variables on having a Pap smear. Results from the data provide support for the existence of a race/ethnicity/immigration status effect. Anglos were more likely to have had a Pap smear, followed by African Americans, Hispanic immigrants, and finally, by Hispanic Americans. The persistence of the race/ethnicity/immigration status effect, even when the effects of other independent/control variables are taken into account, may be explained by several factors. These include cultural differences between the different groups studied. The race/ethnicity/immigration status effect on Pap smear screening changed with the introduction of age, usual source of care, check-up for current pregnancy, and having multiple competing needs for food, clothing and housing into the models studied. Other variables, such as marital status, employment status and health insurance coverage had no statistically significant effects on Pap smear screening. The findings of this study are unique, probably due to the hospital-based sample who has regular access to subsidized health insurance from a publicly funded safety-net healthcare network and its healthcare providers. Given the importance of race/ethnicity/immigration status for preventive Pap smear screening, public education efforts to promote appropriate Pap smear tests among vulnerable populations should target specific race/ethnicity/immigration status groups in the U.S. within the cultural context of each group. Furthermore, publicly funded health programs for underserved populations such as the John Peter Smith Connections and Medicaid should be maintained and strengthened.

A Síndrome da Imunodeficiência Adquirida (aids) configura-se como um dos grandes fenômenos da saúde pública na atualidade. Considerada como uma condição crônica manejável e controlável, porém não curável, torna-se necessário pensar em mecanismos que possibilitem minimizar os episódios de agudização e instabilidade das condições clínicas e de saúde. Esse estudo objetivou analisar as condições clínicas das pessoas que viviam com aids em acompanhamento nos serviços de assistência especializada (SAE) em HIV/aids do município de Ribeirão Preto-SP. Trata-se de um estudo descritivo, do tipo inquérito exploratório. A população do estudo constituiu-se pelas pessoas que viviam com aids (PVHA) em acompanhamento nos cinco SAE da rede pública municipal, no período de julho/2011 a fevereiro/2012, que atendiam aos seguintes critérios de inclusão: idade igual/superior a 18 anos, residentes no município e não pertencentes ao sistema prisional. Foram realizadas entrevistas com apoio de um questionário estruturado. Utilizaram-se fontes primárias e secundárias de informação. Os dados coletados foram digitados, armazenados e analisados por meio do programa Statistica, versão 9.0 da Statsoft. Os indivíduos foram caracterizados em relação ao perfil sociodemográfico e clínico, a partir de técnicas estatísticas descritivas. A seguir, os mesmos foram classificados em quatro grupos específicos, organizados a partir da articulação dos seguintes indicadores: marcadores do HIV/aids (carga viral e doenças oportunistas), situação imunológica (contagem de linfócitos T-CD4+) e a presença de outras condições crônicas. Utilizou-se teste qui-quadrado de proporção para identificar associação entre os grupos formados e as variáveis do perfil sociodemográfico. Foram entrevistadas 301 PVHA. Identificou-se paridade na proporção homens/mulheres, predomínio da faixa etária entre 40 e 64 anos, ensino fundamental incompleto, indivíduos solteiros/divorciados ou viúvos, classe econômica C, empregados/autônomos/afastados e que possuíam moradia própria. Quanto às condições clínicas no momento da entrevista, importante parcela possuía linfócitos T-CD4+ superiores a 500 células (61,5%), carga viral indetectável, ausência de doenças oportunistas e manifestações clínicas. Identificou-se elevado percentual de outras condições crônicas, com destaque para a hipertensão arterial sistêmica. Em relação à constituição dos grupos, mais da metade das PVHA foram classificadas como instáveis. Ao se analisar tais grupos, considerando as variáveis sociodemográficas, houve associação estatística significativa apenas no que se refere à ocupação. Urge a necessidade de delineamento e operacionalização de tecnologias capazes de ampliar a percepção acerca das necessidades e demandas dos das PVHA, oferecendo novas oportunidades para se refletir sobre a organização dos serviços e das práticas de saúde no controle do HIV/aids / The Acquired Immunodeficiency Syndrome (AIDS) is characterized as one of the greatest phenomena of public health today. It is considered a manageable and controllable chronic condition, but without possibilities of cure. For its care one need to consider mechanisms that allow the decrease of instability episodes and the worsening of clinical conditions and health status. This study aimed to analyze the clinical conditions among people living with aids in follow-up at the HIV/AIDS specialized assistance services (SAS) in Ribeirão Preto-SP. This is a descriptive and exploratory survey. The study population was composed by people living with AIDS (PLWHA) in follow-up at five local SAS during the period of July/2011 up to February/2012, who met the following inclusion criteria: aged above 18 years old, living in the city and outside the prison system. Interviews were conducted by using a structured questionnaire. We used primary and secondary sources of information. The collected data were entered, stored and analyzed using the Statistica software, version 9.0 from Statsoft. Individuals were characterized in relation to sociodemographic and clinical profile by applying descriptive statistics techniques. They were then classified into four specific groups, classified through the following indicators: HIV/aids markers (viral load and opportunistic infections), immune status (CD4+ T cell count) and the presence of other chronic conditions. We used chi- square ratio test for identifying association between these groups and the sociodemographic variables. A total of 301 PLWHA were interviewed. We identified male/female ratio parity, and the predominant characteristics: age between 40 and 64 years old, incomplete primary education, single/divorced or widowed individuals, economic class C, employed/autonomous/retired and owning their own house. As for the clinical conditions at the time of interview, a significant amount of interviewees presented CD4+T-cells count over 500 (61,5%), undetectable viral load, clinical manifestations and absence of opportunistic diseases. We identified a high percentage of other chronic conditions, especially hypertension. Regarding the formation of groups, more than half of PLWHA were classified as unstable. A statistically significant association only with regard to the occupation was found when analyzing such groups and considering sociodemographic variables. There is an urgent need to design and operate technologies that expand the perception of PLHA demands, offering new opportunities to reflect on the organization of services and health practices in the control of HIV/aids

Twitter has become a popular channel for local governments to explore crisis communication during a hurricane. Local governments use Twitter to distribute crisis messages to the public, and are able to amplify or attenuate risk perception. Many factors attribute to individuals’ risk perception including control, choice, children, novelty, and risk-benefit tradeoff. The Social Amplification of Risk Framework (SARF) provides a guide to understanding the intensifying or weakening of these risk messages. While these crisis messages are directed to the general public, the local governments may be neglecting information for the vulnerable populations. In order to prepare for a hurricane, vulnerable populations need updates from local governments and emergency agencies before, during, and after the hurricane. Relationships among stages of a hurricane, tweet categories, and risk perception were explored. A sample of 1,043 tweets from six Twitter accounts of local governments in Florida were analyzed to provide insight into what type of messages local governments tweet and what risk perceptions local governments emphasize during the stages of Hurricane Irma. Using a Cross-tabulation analysis, researchers analyzed significant differences for stages of a hurricane, tweet categories, and risk perceptions. Findings for this study indicate that results were significant through each stage of the hurricane. Keywords: Twitter, Hurricane, Risk Factors, SARF, Vulnerable Populations