Felicity Thomas

Transnational health and treatment networks: meaning, value and place in health seeking amongst southern African migrants in London.

Drawing upon research undertaken with migrants from southern Africa living in London, this paper examines the important role played by transnational health networks in influencing individuals treatment seeking decisions. As well as exploring the ways in which these networks provide important sources of help and support for people in times of ill health, the paper examines the ways in which treatments from particular places and contexts carry certain associations, meanings and values, which are in turn, considered vital in influencing health care outcomes.

If I cannot access services, then there is no reason for me to test: the impacts of health service charges on HIV testing and treatment amongst migrants in England.

Abstract Policy governing entitlement to access government health care for foreign nationals in England is a subject of debate, controversy and confusion. Of particular concern to health providers has been the impact of National Health Service charges on delaying HIV testing and anti-retroviral treatment uptake and adherence amongst certain migrant groups. Data obtained through focus groups with 70 migrants from southern Africa, suggest that confusion over health care entitlements exists amongst those seeking health care and is reported amongst health service providers. This confusion, as well as financial difficulties and fears over deportation facing some migrants, can in turn be a factor influencing their decisions to avoid formal health services, resort to alternative and often ineffective or potentially adverse forms of therapy, and delay HIV testing and treatment uptake.

Indigenous narratives of HIV/AIDS: morality and blame in a time of change.

While it is increasingly recognized that contextually relevant HIV prevention and AIDS mitigation interventions are more likely to succeed than enforced generic strategies, relatively little attention has been given to understanding the manner in which affected individuals and communities themselves perceive and subsequently experience the epidemic. Drawing on research undertaken in the Caprivi region of Namibia, this article challenges dominant biomedical HIV/AIDS discourse and demonstrates the important role of alternativeillness narratives in shaping local understandings of and responses to HIV/AIDS. Four interlinked illness narratives are examined: the relationship between illness and resource use, gender and pollution, religious ideas about morality, and witchcraft accusations. Links are made between these narratives and threats to the social and moral order brought about by socioeconomic change. While treatment sought can initially be influenced by the illness narrative employed, an overriding concern to cure the ill person combined with a range of coexisting social pressures to be seen to be doing the “right thing” ultimately play a more significant role in determining treatment.

Global rights, local realities: negotiating gender equality and sexual rights in the Caprivi Region, Namibia.

Gender inequalities are frequently cited as a major reason for high HIV‐prevalence rates in southern Africa. While steps have been taken to promote and pass legislation that upholds equal rights for women, this paper examines the ways in which discourses of gender equality and ensuing sexual rights can have complex, contradictory and even adverse implications when they are mobilised, resisted and reinterpreted at local level. Drawing upon research undertaken in the Caprivi Region of Namibia, this paper examines this ways in which men and women respond to ideas about gender equality, and seeks to place these responses within the wider context of socioeconomic change and understandings of morality prevalent within the region. The tendency of many young women to seek out relationships with older men and the increasing costs of bride‐wealth payments play a key role in reinforcing patriarchal attitudes and fuelling disrespect for womens rights both before and within marriage. In addition, a failure to adhere to customary norms, which uphold mens dominant role, continues to threaten the support networks and assets available to women. The consequences of this situation are examined with particular focus on implications for the future transmission of HIV.

School-Based Sex and Relationships Education: Current Knowledge and Emerging Themes

It is widely accepted that children and young people have the right to education for sexual health, with these rights being enshrined in the UN Convention of the Rights of the Child (UNCRC). According to WHO (2010), knowledge and information provided through sexual health education is essential if people are to access their sexual rights and be sexually healthy. Education for sexual health — called variously sex education, sexuality education or sex and relationships education (hereafter, SRE) — involves the acquisition of information and the opportunity for young people to explore and develop their attitudes, beliefs and values as they relate to gender and sexuality, sexual and gender identity, relationships and intimacy. Sexual health education also aims to develop young people’s knowledge and skills to make informed choices regarding their behaviour, and in so doing, limit their risk and vulnerability to sexual ill-health through factors such as unwanted pregnancy, unwanted, abusive and exploitative sexual activity, unsafe abortion and STIs, including HIV.

The role of natural environments within women’s everyday health and wellbeing in Copenhagen, Denmark

Urbanisation has been linked with sedentary lifestyles and poor mental health outcomes amongst women. The potential for natural environments to enhance physical activity and mental wellbeing in urban areas is now well recognised. However, little is known about the ways that women use natural spaces for health and wellbeing within the context of their everyday lives. This paper draws on ideas developed in the therapeutic landscapes literature to examine how experiences in different types of green and blue space provide important health and wellbeing benefits for women in Copenhagen, Denmark. As well as facilitating physical exercise, such spaces were found to enable a range of more subtle benefits that helped to restore mental wellbeing through stress and anxiety alleviation, the facilitation of emotional perspective, clarity and reassurance, and through the maintenance of positive family dynamics. However, amongst some women who were overweight, the socio-political associations they made with natural environments deterred use of such spaces. Such findings challenge dominant planning and policy assumptions that equate open public access to natural spaces with universal benefit.

Remarriage after spousal death: options facing widows and implications for livelihood security

Remarriage following the death of a spouse has important implications for individual and household livelihoods in rural areas. Research in the Caprivi Region of Namibia found that while widowers commonly remarry, the ‘traditional’ option open to women through widow inheritance has been outlawed. While forcing widows off the land is now prohibited, socio-cultural pressures, the status of the womans children, and a lack of basic support from the late husbands relatives can result in a more subtle form of property disinheritance. In addition to upheaval caused by relocation, many widows are limited in undertaking livelihood activities, constrained in their capacity to engage in profitable income-earning opportunities, and heavily reliant on the support of others.

Medicine ‘misuse’: implications for health and environmental sustainability

Recent decades have witnessed a global rise in the use of medical pharmaceuticals to combat disease. However, estimates suggest that over half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them as directed. Bringing together research from across the medical, natural and social sciences, this paper considers what we know about the causes, impacts and implications of medicine misuse in relation to health, the sustainable use of pharmaceuticals and their unintended effects in the environment. We suggest that greater insight and understanding of medicine misuse can be gained by integrating the biomedical-focused approaches used in public health with approaches that consider the social and environmental determinants of medical prescribing and consuming practices.

Handbook of Migration and Health

Migration is now rmly embedded as a leading global policy issue of the twentyrst century. Whilst not a new phenomenon, it has altered signi cantly in recent decades, with changing demographics, geopolitics, con ict, climate change and patterns of global development shaping new types of migration. Against this evolving backdrop, this Handbook o ers an authoritative overview of key debates underpinning migration and health in a contemporary global context.

Healthy publics: enabling cultures and environments for health

Despite extraordinary advances in biomedicine and associated gains in human health and well-being, a growing number of health and well-being related challenges have remained or emerged in recent years. These challenges are often ‘more than biomedical’ in complexion, being social, cultural and environmental in terms of their key drivers and determinants, and underline the necessity of a concerted policy focus on generating healthy societies. Despite the apparent agreement on this diagnosis, the means to produce change are seldom clear, even when the turn to health and well-being requires sizable shifts in our understandings of public health and research practices. This paper sets out a platform from which research approaches, methods and translational pathways for enabling health and well-being can be built. The term ‘healthy publics’ allows us to shift the focus of public health away from ‘the public’ or individuals as targets for intervention, and away from the view that culture acts as a barrier to efficient biomedical intervention, towards a greater recognition of the public struggles that are involved in raising health issues, questioning what counts as healthy and unhealthy and assembling the evidence and experience to change practices and outcomes. Creating the conditions for health and well-being, we argue, requires an engaged research process in which public experiments in building and repairing social and material relations are staged and sustained even if, and especially when, the fates of those publics remain fragile and buffeted by competing and often more powerful public formations.