Anne Dressel

Marriage as a risk factor for HIV: Learning from the experiences of HIV-infected women in Malawi

Abstract The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of womens lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriages effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what womens experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe womens lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review womens narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.

Safety Planning in Focus Groups of Malawian Women Living With HIV Helping Each Other Deal With Violence and Abuse

In this critical ethnography, 72 HIV-infected women in Southern Malawi participated in 12 focus groups discussing the impact of HIV and violence. Our analysis, informed by a postcolonial feminist perspective, revealed women’s capacity to collectively engage in safety planning. We present our findings about women’s experiences based on narratives detailing how women collectively strategized safety planning efforts to mitigate the impact of violence. This study helps to fill a gap in the literature on the intersection between HIV and violence in women’s lives. Strategies discussed by the women could form a basis for safety planning interventions for women in similar circumstances.

Missed opportunities for early HIV diagnosis: critical insights from the stories of Kenyan women living with HIV

Early HIV testing is critical for prevention and timely treatment. Missed opportunities for HIV diagnosis can result in unnecessary deaths at a time when access to antiretroviral treatment proves lifesaving. While HIV prevention and treatment research has increased, less research exists on womens experiences with HIV diagnosis, despite the fact that women are most affected. Insights from local women are critical in designing culturally meaningful interventions that thwart missed opportunities for early HIV diagnosis. The purpose of our study was to uncover steps women took to know their HIV diagnosis. Using narrative inquiry methodology informed by postcolonial feminism, we interviewed 40 HIV-positive women in Kenya. Five themes emerged related to uptake of HIV testing for women: (1) spouses critical illness or death; (2) years of suffering from HIV-related symptoms; (3) sick children; (4) prenatal testing; and (5) personal desire to know ones HIV status. These findings centered on women experiences provide an important basis for health promotion interventions related to HIV prevention, earlier detection, and treatment.

Local to global: Working together to meet the needs of vulnerable communities

ABSTRACT Since 2012, the University of Wisconsin–Milwaukee (UWM) faculty from nursing and physical therapy (PT) have been working together towards a common goal: to meet the healthcare needs of vulnerable populations in Malawi and Milwaukee. Sharing valuable knowledge and understanding one another’s professions have allowed us to develop interprofessional education (IPE) learning experiences for students to help identify how quality of life could be improved or enhanced for children and their families across two different geographic spaces, one in rural Malawi and the other in urban Milwaukee. IPE learning modules were implemented in UWM’s community health-focused short-term study abroad programmes to Malawi. IPE learning modules were also piloted at one of UWM’s nurse-managed community health centres, located in a low-income, African American community in the inner city of Milwaukee, Wisconsin. Based on survey data collected from 10 participating IPE students in Milwaukee, from nursing, occupational therapy, PT, and speech and language pathology, a pilot study yielded a statistically significant change in a positive direction for increased understanding of three interprofessional collaborative practice core competencies: values and ethics, roles and responsibilities, and teams and teamwork. In this article, we discuss the processes used to develop, implement, and evaluate IPE experiences for UWM students, which may enable other professionals to envision the various projects they can embark upon from an interprofessional perspective.

Enhancing Healthier Birth Outcomes by Creating Supportive Spaces for Pregnant African American Women Living in Milwaukee

Objectives Nationwide, African American women report higher stress levels and less access to pre- and postnatal resources. Wisconsin mirrors national infant mortality trends that show a persistent four-decade gap in infant survival between African American and White populations. The objective of the Milwaukee Birthing Project (MBP) was to implement a community-based health promotion intervention to improve birth outcomes for pregnant, low-income African American women, evaluate its effectiveness, and document its usefulness to inform development of future interventions. The project involved a mentoring and supportive relationship between 28 volunteer mentors (Sister Friends) and 20 pregnant women (Little Sisters). Methods The project implementation and evaluation were informed by the lifecourse perspective and a postcolonial feminist framework. Thematic analysis was used to analyze ethnographic data from monthly meetings and interviews with pregnant Little Sisters and Sister Friends. Results Our findings showed patterns both in community spaces and spaces created during the MBP. Program spaces contrasted with everyday life spaces and allowed women to experience community support. Based on our analysis, we classify these spaces as: (1) community spaces lacking support, (2) safe spaces of belonging and understanding, (3) spaces that foster meaningful interaction, and (4) safe, supportive spaces for other women in the future. Conclusions for Practice Future interventions should consider intentionally developing safe spaces to attain health goals. From a postcolonial feminist perspective, the voices of women who are at greatest risk for experiencing poor birth outcomes are crucial to the development of effective policies.

Assessing Health Promotion Interventions: Limitations of Traditional Research Methods in Community-Based Studies:

Most low-income Americans fail to meet physical activity recommendations. Inactivity and poor diet contribute to obesity, a risk factor for multiple chronic diseases. Health promotion activities have the potential to improve health outcomes for low-income populations. Measuring the effectiveness of these activities, however, can be challenging in community settings. A “Biking for Health” study tested the impact of a bicycling intervention on overweight or obese low-income Latino and African American adults to reduce barriers to cycling and increase physical activity and fitness. A randomized controlled trial was conducted in Milwaukee, Wisconsin, in summer 2015. A 12-week bicycling intervention was implemented at two sites with low-income, overweight, or obese Latino and African American adults. We found that randomized controlled trial methodology was suboptimal for use in this small pilot study and that it negatively affected participation. More discussion is needed about the effectiveness of using traditional research methods in community settings to assess the effectiveness of health promotion interventions. Modifications or alternative methods may yield better results. The aim of this article is to discuss the effectiveness and feasibility of using traditional research methods to assess health promotion interventions in community-based settings.

Healthy Day Cares: An Asthma Health Promotion Project in Milwaukee, Wisconsin

Healthy Homes and Healthy Schools concepts were implemented as part of a pilot project in day care settings located in Westlawn, a low-income African-American community in Milwaukee, Wisconsin. The pilot project, Healthy Day Cares, included a “walk-through” assessment to identify asthma triggers in local day care centers, and the provision of education to day care providers about asthma health, asthma care plans, and how to reduce asthma triggers among children and improve indoor air quality. The pilot project was developed in collaboration with the Wisconsin Asthma Coalition, the Wisconsin Department of Health Services, the University of Wisconsin-Milwaukee College of Nursing, and the Westlawn Partnership for a Healthier Environment.