Submitted by Giovanna Brasil (1154060@mackenzie.br) on 2017-11-06T21:42:18Z No. of bitstreams: 2 Jorge Corrêa dos Santos Filho.pdf: 1276686 bytes, checksum: ac7a2b2d020b42a41019f7ce79cffcde (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Paola Damato (repositorio@mackenzie.br) on 2017-11-21T11:16:36Z (GMT) No. of bitstreams: 2 Jorge Corrêa dos Santos Filho.pdf: 1276686 bytes, checksum: ac7a2b2d020b42a41019f7ce79cffcde (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-11-21T11:16:36Z (GMT). No. of bitstreams: 2 Jorge Corrêa dos Santos Filho.pdf: 1276686 bytes, checksum: ac7a2b2d020b42a41019f7ce79cffcde (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-08-28 / The speech “I Have a Dream”, delivered by Martin Luther King, has echoed throughout the world over the years for political, social and religious reasons. Despite being a deeply studied text, this dissertation aims to approach it within the scope of a hermeneutical analysis of the discourse, seeking to better understand its pertinence and adequacy, both at the time of its pronouncement and in the present day. In its original context, Luther King's speech points to the struggle against racial segregation and the exclusion of civil rights of black Americans. The manner in which the speech and the objectives of the March for Rights and Labor were presented took over the US capital city with people aggrieved for suffering segregation and sensitive to this intolerant attitude. For this, this dissertation, as it aims a Hermeneutic Analysis of the Discourse, recovers historical, social, political and religious contexts. The present study also makes intertextual connections to other Luther King’s conferences, as well as with several moments in which the presence of the text of the Sacred Scriptures can be recognized. Finally, under a contemporary view, this research verifies the current relevance of the theme of "I Have a Dream", a discourse that is constantly re-contextualized and whose theme is always urgent. / O discurso I Have a Dream, proferido por Martin Luther King, tem ecoado pelos cantos do mundo, ao longo dos anos, por motivos políticos, sociais e religiosos. Apesar de ser um texto muito estudado, esta dissertação toma-o, para uma análise hermenêutica do discurso, com a finalidade de melhor compreender sua pertinência e adequação tanto à época de seu pronunciamento, quanto aos dias atuais. Em seu contexto originário, o discurso de Luther King aponta para a luta contra a segregação racial e a eliminação de direitos civis dos negros americanos. A forma como foram apresentados o discurso e os intentos da Marcha por Direitos e Trabalho povoou a capital dos EUA, com pessoas insatisfeitas, por sofrerem as segregações e outras por serem sensíveis a essa atitude intolerante. Para tanto, esta dissertação, ao fixar-se numa proposta de Análise Hermenêutica do Discurso, recupera os contextos histórico, social, político e religioso. O presente estudo faz, ainda, aproximações intertextuais com outras conferências de Luther King e também, com diversos momentos em que se pode reconhecer a presença do texto das Sagradas Escrituras. Por fim, com o olhar voltado para a contemporaneidade, esta pesquisa verifica a atualidade da temática de “I Have a Dream”, discurso que constantemente se retextualiza e cuja temática se faz sempre urgente.

Since the early 1990s with the AIDS pandemic, there has been an increasing interest on the importance of risky sexual behaviors, especially among men who have sex with men (MSM). An important antecedent for these behaviors is alcohol use. Studies consistently show an increased frequency of both alcohol use and risky sexual behaviors in MSM populations. However, to date, there has not been a precise estimate of the effect size in these diverse populations and a consistent way to measure it. More so, the importance of context is often cited as a source of variability, but is rarely measured in these studies. Contextual factors are different and specific for MSM, as they have been approached by two theories, both of which will be guiding this dissertation: Singer’s Syndemic Theory and Meyer’s Minority Stress Theory. Chapter 1, then presents a comprehensive review of both theories as they apply to alcohol use, risky sexual behaviors, and contextual factors driving them. Chapter 2 answers the first research question about effect sizes through a systematic literature review. The effect sizes or measures of association of these contextual risk and protective factors were summarized using meta-analytic techniques. Using five electronic databases, we identified 26 studies in 26 years (1990–2015), all diverse in terms of sampling techniques, assessment of sexual orientation, operationalization of alcohol use and risky sexual behaviors, contextual factors included, and measurement of effect sizes. Despite this diversity, studies reporting an effect size were pooled and summarized using both descriptive and meta-analytic techniques, as appropriate. Meta-analyses were conducted using Cochrane’s guidelines for generic inverse variance outcomes with random effects. The pooled effects of alcohol use on condomless anal intercourse (CAI; OR 1.73 [95% CI 1.43, 2.10], I2 0%), heavy episodic drinking on CAI (OR 1.88 [95% CI 1.25, 2.81], I2 32%), and heavy episodic drinking on condomless oral sex (OR: 8.00; 95% CI 2.48, 25.81), as well as the effects of substance use, mental health status, violence and victimization, and self-reported HIV status as contextual factors in the pathway between alcohol use and risky sexual behaviors were calculated, reported, and discussed along with study limitations and implications for public health. Chapter 3 answers the second research question regarding a standardized measurement model for effect sizes and the multiple mediation of contextual factors. We used the male subset of Wave IV of the AddHealth dataset to test our hypotheses through structural equation modeling approaches, including measurement analysis with invariance testing, path analysis for direct effects, and multiple mediation analysis through bootstrapping for indirect effects. The AUD scale was invariant between MSM and MSW, but the risky sexual behavior scale was not. For MSM, the standardized direct effect of AUD onto risky sexual behaviors was –1.25 and the standardized total indirect effect of the multiple mediation model was 1.58, 95% CI [1.42, 1.73]. Among the mediators, the strongest indirect effect for any measured or latent mediator was the mental health construct (2.09). We conclude that even though AUD has the same measurement structure for MSM and MSW, its effect on risky sexual behaviors does not operate the same way for these two populations, supporting both causal and contextual behavioral theories. Conclusions are individually discussed, respectively, in Chapters 2 and 3. However, Chapter 4 puts both manuscript conclusions in context and further discusses future implications for public health research, practice, and policy.

In 2010, men who have sex with men (MSM) represented 4% of the population in the United States (US) and accounted for 78% of all new Human Immunodeficiency Virus (HIV) infections among Hispanic men. Hispanic men who have sex with men (HMSM) accounted for the third largest number of new HIV infections (6,700 cases). This dissertation explored the effects of age, loneliness, substance use, depression, and social support on high risk sexual behaviors that predispose middle aged HMSM to sexually transmitted infections (STIs) and HIV infection risk. A sample of 150 urban HMSM aged 40 to 65 were surveyed in this study. Singer’s Syndemics Theory (1996) provided this study’s theoretical framework. Data was analyzed using a variety of parametric and non-parametric statistics. Loneliness, social support, depressive symptoms, alcohol/drug use, and sexual risk behaviors were found to have an influence on HIV infection status in this study. Partner status, religious affiliation and age did have an influence on alcohol use in this study’s participants. Also, participants with increased age had increased depressive symptoms in this study. Lastly, depressive symptoms, substance use, social support, and loneliness did have an influence on sexual risk behaviors in this study’s participants, specifically alcohol use and illicit drug use. The findings from this study should be used to assess, diagnose, plan, implement and evaluate prevention strategies geared to reduce STI and HIV infection in this population. Future research should build on these findings and develop tailored risk reduction interventions addressing HMSM, with particular attention to the understudied age group of the middle aged HMSM.

À partir de notre expérience clinique auprès de personnes incarcérées, notre travail de recherche propose une modélisation théorique du concept de passage à l’acte dans son rapport à l’instance du Surmoi. Il s’agit ainsi de dégager les enjeux métapsychologiques du concept de Surmoi tels qu’ils se présentent dans la clinique des passages à l’acte, et plus spécifiquement dans le versant de l’acte criminel, en retraçant les conditions de son élaboration théorique. Si Freud pose les fondements essentiels à notre réflexion, les concepts kleiniens de Surmoi primitif et de position schizo-paranoïde nous seront bien plus précieux pour tenter de penser le retour de certains fonctionnements placés sous la domination d’un Surmoi particulièrement cruel et destructeur. Cet aspect repris par Lacan sous la forme impérative du Surmoi servira de base à nos propos. Si l’instance surmoïque est initialement repérée dans sa fonction de conscience morale en tant qu’instance légiférante, il est également question d’une double polarité plus paradoxale qui se fait l’envers de la Loi par une injonction féroce et cruelle de jouissance. Dans cette perspective, le passage à l’acte criminel se présente comme la réponse irrépressible à l’injonction d’un Surmoi fort aux actions sévères et virulentes. Ce travail insiste notamment sur l’acte criminel comme ultime recours. Un recours pour se dégager de la position d’objet de jouissance de l’Autre et la tentative de surgir ailleurs, comme sujet. / From our clinical experience with prison inmates, our research work proposes a theoretical paradigm of the concept of acting-out in relation with the superego instance. The purpose is thus to bring out the metapsychological stakes and issues of the superego concept as they appear in the clinical approach of the acting-out, and more specifically in relation with the criminal act, while tracing back the conditions of its theoretical elaboration. Even if the foundations that Freud laid is essential to our reflection, the kleinian concepts of primitive superego and of paranoid-schizoid position will be far more precious to us in this endeavour to reflect on the reappearance of certain modes of functioning which are under the supremacy of a particularly cruel and destructive superego. This aspect, which Lacan has reformulated with his view of an imperative superego, will provide the basis for our discourse. While the superego instance is first identified through its function of moral consciousness, as a legislating instance, there also exists a more paradoxical double polarity whereby the reverse side of the Law is expressed through a ferocious and cruel injunction to have enjoyment (“jouissance”). Within this perspective, the criminal acting-out appears like the irrepressible response to the injunction of a strong Superego pushing to commit harsh and virulent actions. This thesis notably insists on the criminal act seen as a last resort. A resort which aims at releasing oneself from the position where one has become the object of the Other's “jouissance”, while one tries, at the same time, to be a subject.

In this research, we trace the sociolinguistic profile of the speakers from the state of Alagoas concerning the variation of the verbs "ter" and "haver" in existential constructions, in order to analyse how that variation occurs and verify if the alternance of those verbs, in the alagoana speech, reflects either a process of stable variation or a change in progress. For the development of this work, we appeal to the Theory of Linguistics Variation (LABOV, 2008[1972]) which deals the variation and linguistics change and includes the variable use of the language in its social context. In this way, after the delimitation of the dependent variable and of the independent variables selected as potentially relevant in the variation under analysis, namely, animacity of the internal argument, nature of the internal argument, verbal tense, gender, age and scholarity, we stratify our sample and we did the gathering and transcription of data, as well as, the analysis and codification of all existential constructions formed with the verbs present in the corpus. For the quantitative analysis, we use the software VARBRUL, which delimited the variables statically nonsignificant and the variables statically significant in variation under study, showing not only that there is variation “ter” and “haver” existentials in the community studied and that the uses of “ter” existential is greater than the uses of “haver” existential, as well as that such variation is conditionated by the factor groups scholarity, verbal tense, age and nature of internal argument, leading us to argue that, in the alagoana speech, such variation reflects a process of change in cours in the direction of “ter” existential. / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Nesta pesquisa, traçamos o perfil sociolinguístico dos falantes alagoanos em relação à variação dos verbos ter e haver em construções existenciais, com o intuito de analisar como essa variação ocorre e de verificar se a alternância desses verbos, na fala alagoana, reflete um processo de variação estável ou de mudança em progresso. Para o desenvolvimento deste estudo, recorremos à Teoria da Variação Linguística (LABOV, 2008[1972]) que trata da variação e da mudança linguística e contempla os usos variáveis da linguagem em seu contexto social. Dessa forma, após a delimitação da variável dependente e das variáveis independentes selecionadas como potencialmente relevantes na variação em estudo, a saber, animacidade do argumento interno, natureza do argumento interno, tempo verbal, sexo, faixa etária e escolaridade, estratificamos nossa amostra e fizemos não só a coleta e a transcrição dos dados, mas também a análise e a codificação de todas as construções existenciais formadas com os verbos ter e haver presentes no corpus. Para a análise quantitativa dos dados, utilizamos o programa computacional VARBRUL, que delimitou as variáveis estatisticamente não significativas e as variáveis estatisticamente significativas na variação em estudo, mostrando não só que há variação ter e haver existenciais na comunidade estudada e que o uso de ter existencial é bem maior do que o uso de haver existencial, como também que tal variação é condicionada pelos grupos de fatores escolaridade, tempo verbal, faixa etária e natureza do argumento interno, levando-nos a argumentar que, na fala alagoana, tal variação reflete um processo de mudança em curso na direção de ter existencial.

AbstractAnalysing the Impact of Stigma and Discrimination on the Linkages Across the Continuum of HIV Services for Men who have Sex with Men: A Realist ApproachBackground and Aim The world has now entered the third decade of the AIDS epidemic. Men who have sex with men (MSM) continue to be disproportionately affected by HIV/AIDS. Haiti still struggles in its response to this ongoing crisis throughout the continuum of services: disease prevention, treatment, and HIV related stigma, prejudice, and discrimination. Much of the information reported on people living with HIV has come from the general population, but only a few parts of some of those studies have focused on MSM. Therefore, the overall aim of this dissertation was to analyse the impact of stigma and discrimination on the continuum of HIV services for MSM in order to ascertain why, how and under which circumstances MSM are engaged, linked and retained along the care continuum.Methods For this dissertation, data were collected via literature review, electronic medical records, participant observations, focus groups and semi structured interviews with medical students, health care workers and MSM. Using a realist approach based on mixed methods design we sought to address the influence of HIV and sexual stigma on the continuum of HIV services and to identify key mechanisms emerging from the context and leading to the outcomes. Quantitative social and medical data were gathered and analysed to produce descriptive and analytic statistics and qualitative data were analysed thematically regarding the objectives.FindingsResults indicated that MSM experienced stigma in multiple and overlapping layers. MSM described stigmatizing experiences stemming from religious sources, communities, family and friends, and from the medical establishment. From the social construction of heteronormativity in the society, several social and cultural factors, gender norms lie behind the stigma associated with sexual orientation and HIV. Moreover, medical students and healthcare givers still carry discriminatory attitudes towards them despite tailored interventions. Our analysis showed that current service delivery models are less than optimal in linking and retaining MSM, resulting in loss to follow-up in the continuum of care and failure to fully realize the health and prevention benefits. However, multi-level, contextual-based and socially accountable interventions can produce stigma mitigation through personal, health systems’ and contextual mechanisms for better engagement, adherence and retention throughout the continuum.ConclusionsThe results within this dissertation are intended to inform health professionals in the planning and implementation of interventions for better continuum outcomes in Haiti and similar contexts. This thesis provides insight and contextual information for a socially accountable framework of adapted interventions. To end the AIDS epidemic by 2030, Haiti, the Caribbean region and the entire world urgently need to defy expectations to reach the left behind.KeywordsHIV; Continuum of HIV Services; Stigma; Discrimination; Realist Evaluation; Context-Mechanism-Outcome; Social Accountability / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

Sex education through the public school system has been identified by the Centers for Disease Control and Prevention as an excellent vehicle by which HIV prevention education can be presented to students, thereby decreasing the rate of HIV infection among young men who have sex with men (YMSM). However, YMSM continue to be at high risk for HIV infection in the United States despite educational efforts to prevent infection. The purpose of this qualitative study using a phenomenological approach was to explore what impact school-based HIV prevention education had on YMSM in the past, and what effect that education has had on their current sexual behaviors. The theoretical foundation for this study was the health belief model. Individual 1-hour interviews were conducted with 13 YMSM (ages 21-35) who received HIV prevention education in California. Interviews were analyzed for common themes using a phenomenological approach. Results of this study suggest that participants were not utilizing safer techniques taught in the school HIV prevention education because there was a lack of curriculum consistency, LGBTQ content, and classroom management, and the impact of stigma and homophobia on YMSM. These results support the health belief model. Findings support that positive social change can be achieved by providing standardized, all-inclusive, non-judgmental, HIV prevention education program, in a classroom environment where it is safe to receive same-sex sexual information. This should decrease the number of HIV+ test results among YMSM.

abstract: The Centers for Disease Control and Prevention (2017) note that gay, bisexual, and other men who have sex with men (collectively referred to as MSM) face more barriers to accessing health care compared to other men. Such barriers include, lack of cultural- and sexual identity-appropriate medical and support services, concerns about confidentiality, and fear of discussing sexual practices or orientation in a medical setting. In comparison to other MSM populations, Latino MSM (LMSM) report having the least amount of access to health care (McKirnan et al., 2012). The purpose of the present study is to elucidate how individual- (i.e., age, education level, and income level), community- (i.e., social support and neighborhood collective efficacy), and sociocultural-level factors (i.e., immigration status, heterosexual self-presentation, sexual identity commitment, sexual identity exploration, and ethnic identity affirmation and belonging) may relate with perceived access to healthcare. It is hypothesized that ethnic identity affirmation and belonging will moderate relations between the aforementioned predictors and perceived access to health care based on increasing evidence that ethnic identity, or one’s sense of affirmation and belonging to one’s ethnic group, may be a health protective factor. Among a sample of 469 LMSM, this study found that there were several predictors across all three levels (i.e., individual, community, and sociocultural) of perceived access to healthcare. Additionally, data supported evidence that ethnic identity affirmation and belonging (Phinney, 2003) acts as a moderator of other predictors of perceived access to healthcare in this sample. These findings can inform outreach interventions of researchers and healthcare providers about psychosocial and cultural barriers and facilitators of access to healthcare. / Dissertation/Thesis / Masters Thesis Counseling Psychology 2020

Background. Despite the prevalence of sex work and strip clubs across Canadian urban geographies, few studies explore the occupational health and safety outcomes related to indoor male sex work, let alone male stripping whereby men dance for men. Moreover, the sexual service negotiation process in the sex work industry remains to be explored. In knowing that sexual practices with high HIV/STI rates occur in strip clubs (e.g., condomless oral, vaginal, and anal sex), as well as widespread psychoactive substance use among strippers, the purpose of this study was to explore the cultural features of male strippers’ work that impact their health and safety outcomes. Methodology. For this study, we recruited 14 male strippers working with male clients in a Canadian city. Critical ethnography was our espoused methodology. Through field observations, informal conversations, questionnaires, and semi-structured qualitative interviews, we explored the process of sexual transactions between strippers and clients. We used a postmodern angle to interpret our findings through the works of Deleuze, Guattari, and Foucault. Findings. The male strip club is a social matrix produced by the intersection of motivational forces: the motivation to gain money, pleasure, or intimacy, and the motivation to abide by socio-cultural and legal norms. It is upon a matrix of financial necessity and socio-cultural and legal constraints that sex work transactions unfold in the club. Moreover, the club’s health and safety conditions and strippers’ transaction outcomes result from intersecting motivations. Finally, sexual service negotiation is a process of configuring motivational forces between social agents. The motivation for financial gain revealed itself to be the strongest and most consistent force; the focus on capital gain generated asymmetrical connections between strippers, clients, and business entrepreneurs, resulting in specific health and safety outcomes. Conclusion. The Canadian legal and political context surrounding male sex work negatively impacts male strippers’ occupational health and safety conditions by disabling safe connections with clients. Further, the emphasis on money-making activities encourages strippers to value financial gain over their physical and mental integrity. In short, the male strip club work environment is configured in a manner whereby capital gain is prioritized and strippers’ health and safety is undermined.

Background: Nurses work closely with patients to improve care and alleviate suffering among PLHIV. However, the segregation of MSM in society and the criminalization of same-sex behaviours have caused great havoc causing deaths and suffering in developing countries for more than three decades since the scourge of HIV/AIDS emerged. Aim: The study aimed to illuminate the caring encounters in nursing management of HIV/AIDS among MSM living in Nairobi, Kenya. Method: Five semi-structured interviews were conducted to nurses and data analysed through thematic analysis. Results: Four themes were constructed; the importance of holistic care approach, operanalization of empowerment, the need for sensitization, and living in segregation. Eight sub-themes were formulated: achieving positive patient ́s wellbeing, effective nurse-patient relationship, improving health awareness, provision of social support, conflicts of values, judgmental nurses, rejection of MSM in the society, and rampant discrimination of MSM. Conclusion: Sensitized nurses on MSM sexual behaviours provide holistic care and empower MSM in the management of HIV/AIDS, unlike the ones who still hold onto homophobic prejudice based on religious, cultural and personal beliefs. The study recommends the training of nurses to be aware of the harmful societal attitudes, beliefs, rejection, and discrimination that hinders the effective management of HIV/AIDS. / Bakgrund: Sjuksköterskor arbetar nära medpatienterna för att förbättra omvårdnad och lindra lidandet bland de som lever med HIV/AIDS. Dock orsakar segregeringen av MSM i samhället och kriminaliseringen av samkönat sexbeteende avsevärt kaos vilket orsakar död och lidande i utvecklingsländer i mer än tre decennier sedan plågan av HIV/AIDS börjande. Syfte: Studien syftar till att belysa bemötande vid omvårdnaden vid hanteringen av HIV/AIDS bland MSM som bor i Nairobi, Kenya. Metod: Fem semistrukturerade intervjuer utfördes med sjuksköterskor och data analyserades medelst tematisk analys. Resultat: Fyra teman identifierades: vikten av holistiskt tillvägagångssätt vid omvårdnad, operalisering av bemyndigande, behovet av sensibilisering, och att leva i segregering. Åtta underteman formulerades: att uppnå positivt välbefinnande hos patienter, effektiva sjuksköterska-patient-förhållanden, förbättra hälsomedvetenhet, tillhandahållande av socialt stöd, värdekonflikter, fördömande sjuksköterskor, förkastande av MSM i samhället, och utbredd diskriminering av MSM. Slutsats: Sensibiliserade sjuksköterskor avseende sexuella beteenden hos MSM tillhandahåller holistisk omvårdnad och bemyndigar MSM i hanterandet av HIV/AIDS, till skillnad från de som håller fast vid homofobiska fördomar baserade på religiösa, kulturella och personliga övertygelser. Studien rekommenderar att utbildningen av sjuksköterskor uppmärksammar skadliga sociala attityder, övertygelse, förkastelse, och diskriminering som hindrar effektiv hantering av HIV/AIDS.