Mark B. Padilla

HIV testing and disclosure: a qualitative analysis of TB patients in South Africa

Abstract In South Africa, more than 60% of TB patients have HIV co-infection. Voluntary counseling and testing (VCT) is critical to effective HIV prevention, and TB facilities are optimal venues for delivery of these services. This study employed qualitative research methods to explore the decision-making processes for HIV testing and serostatus disclosure by 21 patients hospitalized with multi/extensively-drug resistant TB (M/XDR-TB) in Durban, KwaZulu Natal. Data collected from in-depth interviews characterized 3 broad themes: HIV testing history, experiences and perceptions of stigma and disclosure, and the relationship between TB and HIV/AIDS. Fear of AIDS-related stigma, the singular stress of TB infection, the absence of partners consent, asymptomatic or incurable disease, and uncertainty about subsequent eligibility for antiretroviral treatment while still receiving TB treatment were identified as potential barriers to the uptake of VCT. HIV serostatus disclosure was impeded by the felt stigma of a ‘discreditable’ infection, manifested by social rejection and discrimination. The Public disclosure of TB illness helped relieve some co-prevention measures such as VCTare likely to be more effective within TB facilities if greater sensitivity is paid to TB patients’ specific social issues and perceptions. These patients are not only at greater risk for HIV co-infection but also for experiencing the double stigma of TB and HIV/AIDS.

HIV/AIDS and Tourism in the Caribbean: An Ecological Systems Perspective

The Caribbean has the highest HIV rates outside of sub-Saharan Africa. In recent decades, tourism has become the most important Caribbean industry. Studies suggest that tourism areas are epicenters of demographic and social changes linked to HIV risk, such as transactional sex, elevated alcohol and substance use, and internal migration. Despite this, no formative HIV-prevention studies have examined tourism areas as ecologies that heighten HIV vulnerability. HIV/AIDS research needs to place emphasis on the ecological context of sexual vulnerability in tourism areas and develop multilevel interventions that are sensitive to this context. From our review and integration of a broad literature across the social and health sciences, we argue for an ecological approach to sexual health in Caribbean tourism areas, point to gaps in knowledge, and provide direction for future research.

“Stuck in the Quagmire of an HIV Ghetto”: The meaning of stigma in the lives of older black gay and bisexual men living with HIV in New York City

In this paper, we analyse the life history narratives of 10 poor gay and bisexual Black men over the age of 50 living with HIV/AIDS in New York City, focusing on experiences of stigma. Three overarching themes are identified. First, participants described the ways in which stigma marks them as ‘just one more body’ within social and medical institutions, emphasising the dehumanisation they experience in these settings. Second, respondents described the process of ‘knowing your place’ within social hierarchies as a means through which they are rendered tolerable. Finally, interviewees described the dynamics of stigma as all-consuming, relegating them to the ‘quagmire of an HIV ghetto’. These findings emphasise that despite advances in treatment and an aging population of persons living with HIV, entrenched social stigmas continue to endanger the well-being of Black men who have sex with men.

The Embodiment of Tourism among Bisexually-Behaving Dominican Male Sex Workers

While theories of “structure” and social inequality have increasingly informed global health efforts for HIV prevention—with growing recognition of the linkages between large-scale political and economic factors in the distribution and impact of the HIV/AIDS epidemic—there is still little theorization of precisely how structural factors shape the very bodies and sexualities of specific populations and groups. In order to extend the theoretical understanding of these macro-micro linkages, this article examines how the growth of the tourism industry in the Dominican Republic has produced sexual practices and identities that reflect both the influence of large-scale structural processes and the resistant responses of local individuals. Drawing on social science theories of political economy, embodiment, and authenticity, I argue that an understanding of patterns of sexuality and HIV risk in the region requires analysis of how political-economic transformations related to tourism intersect with the individual experiences and practices of sexuality on the ground. The analysis draws on long-term ethnographic research with bisexually behaving male sex workers in two cities in the Dominican Republic, including participant observation, in-depth interviews, focus groups, and surveys. By examining the global and local values placed on these men’s bodies and the ways sex workers use their bodies to broker tourists’ pleasure, we may better understand how the large-scale structures of the tourism industry are linked to the specific meanings and practices of sexuality.

Spatial stigma and health inequality

A large body of literature has considered the way that places contribute to the health of their residents. The bulk of this research has considered the numerous risks and resources that are contained within the bounded spaces of neighborhoods and communities. Only recently have scholars begun to consider how these material and social conditions interact with the symbolic dimensions of place to further affect health. In this conceptual paper, we draw on a broad literature in order to develop a conceptual framework that connects negative representations of place, or spatial stigmas, to health. We argue that spatial stigma can affect health through three primary pathways: (1) access to material resources; (2) processes of stress and coping; and (3) processes related to identity formation and identity management. Our model suggests that spatial stigma is likely an important and understudied mechanism through which disadvantaged places contribute to multiple physical and mental health outcomes. Furthermore, by considering the larger sociocultural meanings that surround marginalized places, the concept of spatial stigma introduces new considerations for the development of effective policies to address geographic health inequality.

Globalization, Structural Violence, and LGBT Health: A Cross-Cultural Perspective

It is a daunting task to provide even a partial analysis of the health of lesbians, gays, bisexuals, and transsexuals (LGBTs) from a global perspective owing to the cross-cultural and regional variation in the social construction and expression of sexuality as well as the still incomplete scholarly literature on the topic. This chapter, however, argues that it is precisely such a global vantage point that is required to apprehend the contemporary context of health and illness among LGBT populations. Although LGBT health is shaped by local cultural meanings and practices, it is also inherently embedded in large-scale processes and the position of local LGBT populations within the global system. In the era of a highly mobile, hybrid, and fundamentally interconnected world in which material and symbolic cultures are linked across vast distances, the meanings of LGBT sexuality and their consequences for health in specific locales cannot be understood if nations are viewed in isolation (Altman, 1989). Indeed, the nature of global interconnectedness requires us to engage LGBT health as a fundamentally transnational phenomenon involving the interplay of meanings, practices, and vulnerabilities that extend beyond the purely local. For example, the acquired immune deficiency syndrome (AIDS) epidemic among gay-identified men in the United States and Europe may be intimately related to the meanings and practices that drive risky practices in Papua New Guinea, Uganda, or Bolivia.

A Syndemic Analysis of Alcohol Use and Sexual Risk Behavior Among Tourism Employees in Sosúa, Dominican Republic:

The Dominican Republic has high rates of HIV infection and alcohol consumption. Unfortunately, little research has been focused on the broader sources of the synergy between these two health outcomes. We draw on syndemic theory to argue that alcohol consumption and sexual risk behavior are best analyzed within the context of culture and economy in Caribbean tourism spaces, which produce a synergy between apparently independent outcomes. We sampled 32 men and women working in the tourism industry at alcohol-serving establishments in Sosúa, Dominican Republic. Interviewees described alcohol consumption as an implicit requirement of tourism work, tourism industry business practices that foster alcohol consumption, and an intertwining relationship between alcohol and sexual commerce. The need to establish relationships with tourists, combined with the overconsumption of alcohol, contributed to a perceived loss of sexual control, which participants felt could impede condom use. Interventions should incorporate knowledge of the social context of tourism areas to mitigate the contextual factors that contribute to HIV infection and alcohol consumption among locals.

Interpersonal Relationships and Social Support in Transitioning Narratives of Black Transgender Women in Detroit

Information about the health and well-being of transgender communities is sparse, and even less is known about ethnic minority transgender communities. The little research that exists suggests that transgender women suffer high rates of HIV seropositivity, poor mental health outcomes, and body-modification-related health problems, challenges that are intensified among some ethnic minority communities (Garofalo, Deleon, Osmer, Doll, & Harper, 2006; Golub, Walker, Longmire-Avital, Bimbi, & Parsons, 2010; Nemoto, Bodeker, & Iwamoto, 2011). Even so, transgender communities are tremendously resilient in the face of transphobia and great structural disadvantage (Bith-Melander et al., 2010; Fish, 2012). Social support has been shown to play a key role in overcoming adversities associated with marginalized identities, including racial and sexual minority statuses in the United States (Brown, 2008; Graham, 2012). Yet there is a dearth of information regarding psychosocial determinants of health, such as the role of social networks in the gender transition process and the well-being of transgender communities—including ethnic minority transgender communities. The role of social networks in influencing health outcomes may be particularly important among individuals of multiple marginalized identities, such as Black transgender women, whereby support derived from networks may mitigate the negative effects of transphobia and racial discrimination (Nemoto et al., 2011). Given the role of social resources in determining health outcomes, considering gender transition experiences and identity development in the context of social networks is likely a meaningful approach to understanding vulnerabilities and

Spatial Stigma and Health in Postindustrial Detroit.

An emerging body of research suggests that those who reside in socially and economically marginalized places may be marked by a stigma of place, referred to as spatial stigma, which influences their sense of self, their daily experiences, and their relations with outsiders. Researchers conducted 60 semistructured interviews at partnering community-based organizations during summer 2011 with African American and Latina/o, structurally disadvantaged youth of diverse gender and sexual identities who were between 18 and 26 years of age residing in Detroit, Michigan. The disadvantaged structural conditions and dilapidated built environment were common themes in participants’ narratives. Beyond these descriptions, participants’ framings and expressions of their experiences in and perceptions of these spaces alluded to reputational qualities of their city and particular areas of their city that appear related to spatial stigma. Young Detroit residents articulated the ways that they experience and navigate the symbolic degradation of their city.

Experiences of Violence Among Transgender Women in Puerto Rico: An Underestimated Problem

ABSTRACT Violence is a public health concern faced on a daily basis by transgender women. Literature has documented how it adversely affects quality of life and health and in some instances leads to homicide. Considering the lack of research documenting the experiences of violence among transgender women, the objective of this article was to explore manifestations of violence among this population in Puerto Rico. The data presented in this article are part of a larger study on transgender/transsexual health in Puerto Rico. For the purpose of this article we focus on the quantitative data analysis. Participants (N = 59 transgender women) were recruited via respondent driven sampling. Implications and specific recommendations are discussed in light of these findings.