Ronny A. Shtarkshall

Migration and HIV prevention programmes: linking structural factors, culture, and individual behaviour—an Israeli experience

Migration is one of the structural factors associated with HIV infections, but the dynamic and complex role of migrant situations as determinants of HIV-related vulnerability is still a major issue for social science research. Moreover, interventions to address the specific structural and contextual factors inherent in this association are limited and many do not take into account the cultural components. This paper presents a multi-level framework for analysis of the links between migration and HIV. It includes the association of migration with structural macro factors-lower socio-economic status and limited power in the new society; intermediate structural factors-limited social capital and bi-directional interaction of cultural norms; and individual-level factors-stressors unique to the migration context, depleted psychosocial resources, loss of cultural beliefs and low use of health services. All these factors affect risky sexual behaviour and transmission of HIV. The paper utilises those elements of the framework that are relevant to the specific needs of immigrant populations from the former Soviet Union and from Ethiopia in Israel. We demonstrate their application to integrated, multi-level HIV prevention interventions and propose several special principles for development of migration-related HIV prevention programmes.

Online Health Information Seeking Among Jewish and Arab Adolescents in Israel: Results From a National School Survey

This study examined patterns and determinants of seeking online health information among a nationally representative sample of 7,028 Jewish and Arab 7th- through 12th-grade students in 158 schools in Israel. Nearly all respondents (98.7%) reported Internet access, and 52.1% reported having sought online health information in the past year. Arab students (63%) were more likely than Jewish students (48%) to seek online health information. Population-group and sex differences in health topics sought online were identified, although fitness/exercise was most common across groups. Multivariate regression models revealed that having sought health information from other sources was the strongest independent correlate of online health information–seeking among Jews (adjusted odds ratio = 8.93, 95% CI [7.70, 10.36]) and Arabs (adjusted odds ratio = 9.77, 95% CI [7.27, 13.13]). Other factors associated with seeking online health information common to both groups were level of trust in online health information, Internet skill level, having discussed health/medical issues with a health care provider in the past year, and school performance. The most common reasons for not seeking online health information were a preference to receive information from a health professional and lack of interest in health/medical issues. The closing of the digital divide between Jews and Arabs represents a move toward equality. Identifying and addressing factors underpinning online health information–seeking behaviors is essential to improve the health status of Israeli youth and reduce health disparities.

Quality of online health information about oral contraceptives from Hebrew-language websites

BackgroundThe Internet is a frequently used source of health information. Adolescents in particular seem to be receptive to online health information (OHI) and often incorporate such information in their decision-making processes. Yet, OHI is often incomplete, inaccurate, or unreliable. This study assessed the quality of Hebrew online (non-user-generated) content on oral contraceptives (OC), with regard to accuracy/completeness, credibility, and usability.MethodsTwenty-nine websites in Hebrew, including those of the four Israeli HMOs, were identified and evaluated. The websites were categorized as: HMO, health portal, contraception-specific, promotional-commercial, and life style and women’s health. A set of established content parameters was selected by a family planning expert to assess accuracy/completeness. The Health on the Net Foundation Code of Conduct (HONcode) principles were used to assess the websites’ reliability. Usability was assessed by applying items selected from the Minervation Validation and the University of Michigan’s ′Website Evaluation checklist′ scale. Mean scores, standard deviations (SD), and ranges were calculated for all websites and for category-specific websites. Correlation between dimensions and Inter-rater reliability were also examined.ResultsThe mean score for accuracy/completeness was 50.9% for all websites (SD=30.1%, range 8–100%). Many websites failed to provide complete information, or provided inaccurate information regarding what to do when a pill is missed and when to use back–up methods. The average credibility score for all websites was 70.6% (SD=15.1, range=38=98%). The credibility parameters that were most commonly absent were funding source, authoring, date of content creation and last modification, explicit reference to evidence-based information, and references and citations. The average usability score for all websites was 94.5% (SD=6.9%, range 79–100%). A weak correlation was found between the three quality parameters assessed.ConclusionsWide variation was noted in the quality of Hebrew-language OC websites. HMOs’ websites scored highest on credibility and usability, and contraceptive-specific websites exhibited the greatest accuracy/completeness. The findings highlight the need to establish quality guidelines for health website content, train health care providers in assisting their patients to seek high quality OHI, and strengthen e-health literacy skills among online-information seekers, including perhaps health professionals.

A model-based evaluation of a cultural mediator outreach program for HIV+ Ethiopian immigrants in Israel.

This article presents a model-based evaluation of a program designed to reduce HIV transmission from HIV-infected Ethiopian immigrants in Israel. Rather than rely on self-reported variables such as condom use, this study’s approach focuses on pregnancy rate reduction, estimated from administrative periodic reporting data, as a measure of unprotected sexual exposure. The models show that among both HIV+ women and the female sex partners of HIV+ men, the ongoing pregnancy rates estimated during the intervention were significantly lower than the estimated baseline pregnancy rates, suggesting reductions in unprotected sexual exposures among those participating in the program.

What do women gain from volunteering? The experience of lay Arab and Jewish women volunteers in the Women for Women's Health programme in Israel.

Ambiguous feelings regarding women engaging in formal volunteering and concerns about their exploitation might explain the dearth of studies regarding the volunteering benefits specifically experienced by low socioeconomic status women. The current study examined benefits of volunteering among women participating in Women for Womens Health (WWH), a lay health volunteers (LHV) programme implemented in Jewish and Arab communities in Israel, and aiming at empowering such women to become active volunteers and promote health activities in their communities. Two years after the introduction of WWH in each community, all 45 Jewish and 25 Arab volunteers were contacted by phone and invited to participate in the focus group discussions. Five focus group discussions were conducted with 25/42 Jewish volunteers in 2003 and four with 20/25 Arab volunteers in 2005. The other volunteers could not attend the scheduled meetings or became inactive for personal reasons. Four benefit categories were identified in both ethnic groups: 1. Personal benefits of having increased knowledge, feeling self-satisfaction, mastering new skills and performing healthy behaviours; 2. Group-social benefits of social support and sense of cohesion; 3. Purposive benefits of achieving the WWH mission and goals; 4. Sociopolitical benefits of learning to accept the other and experiencing increased solidarity. However, the relatively less privileged Arab volunteers enumerated more benefits within the personal and purposive categories. They also identified the unique sociocultural category of improving womens status in the community by creating a legitimate space for women by public sphere involvement, traditionally solely a male domain. We conclude that volunteering in community-based health promotion programmes can be an empowering experience for lay women without being exploitative. Positive volunteering benefits will be even more discernable among underprivileged women who enjoy fewer opportunities in the personal and public domains. More studies need to explore volunteering benefits as reported by LHVs, making these benefits more visible and desirable.

A socio-ecological analysis of Ethiopian immigrants' interactions with the Israeli healthcare system and its policy and service implications.

Objective. Despite receiving full medical care and many social services, many Ethiopian immigrants in Israel feel frustrated, and even alienated, by the care they receive. This study uses a qualitative approach to explore the obstacles Ethiopian immigrants face regarding effective health seeking behavior and optimal interactions with healthcare providers in Israel. Design. We gained a three-cornered perspective by conducting semi-structured interviews with healthcare providers, immigrants, and interpreters who mediate between the two. An ecological system or socio-ecological model guided the data analysis. It allowed organizing the varied and complex relationship between the factors that influence healthcare delivery and receipt among this population. Results. The advanced analysis of our results delineated four themes which we grouped into two domains: the cultural divide and the interpreters. Within each of these themes, we explored influences on health or healthcare at each level of the socio-ecological model. We demonstrated that the problems surrounding health seeking behaviors and receiving treatment stem mainly from a cultural divide. This cultural incongruity and its effects are apparent at multiple levels of the ecological model and must be recognized and addressed programmatically at these levels. Conclusions. Necessary program and service modifications include that cultural mediation become an integral part of health personnels training for healthcare delivery and a necessary criterion for good practices. We recommend that professionals from within the health system be trained to act as interpreters. Lastly, the integration of traditional healers into the allopathic health system should be considered. These modifications require a system-wide change in policy, structure of services, and practices.

Diminishing gender differences in condom use among a national sample of young israeli men and women between 1993 and 2005.

BACKGROUND Studies related to condom use among young adults consistently point to substantial gender disparities, although the use has generally increased. This study examined trends in condom use between 1993 and 2005 among 13,988 Israelis aged 18-25 years and the associated sociodemographic factors. METHODS An HIV/AIDS Knowledge, Attitudes, and Practice survey was self-administered to dischargees from Israels compulsory military service. Multivariate logistic regression models were used to assess trends in condom use and the association over time of sociodemographic factors and sexual behaviors with consistent condom use. RESULTS During the 13-year period, consistent condom use increased among men (from 35% to 58%) and women (from 17% to 54%), almost eliminating the gender difference. Among both genders, consistent condom use was associated with being single, being older at the time of sexual debut, and being religious, and was inversely associated with age and education; however, gender differences were found in the strength of the associations over time. CONCLUSIONS The excess risk of exposure of young women to lack of condom use has minimized, an unusual situation on international comparison, although population risk for HIV and sexually transmitted infections exists in Israel. Further understanding of factors influencing the decreasing gender differences is required to reorient and tailor HIV/AIDS interventions to most effectively reach young adults of both sexes.

A woman with a high capacity for multi-orgasms: a non-clinical case-report study

This study is a qualitative study of one womans capacity to reach more than one hundred orgasms during one sexual “session”. The study is based on her written account of her capacity and interviews. This paper focuses on her current orgasmic capacity, the factors affecting it, and “Anonymous” (ANs) experiences and emotional responses related to it. Although for AN her sexual capacity was, and still is, highly important and consuming, it was pleasuring and under control. As a highly sexual woman, she experienced the tension of acting out her sexual desires and straying from societal convention. Consequently, fantasy was one of the ways that her needs were met. It is apparent both from the available literature and from this study that a womans capability to have multiple orgasms is dependent on a combination of developmental, psychological and psychosocial conditions. It is not known if there are unique physiological and biochemical enabling mechanisms. “Anonymous” has consented to have laboratory tests and brain imaging performed and currently efforts are being made to carry these out.

It takes two to tango but one to infect (On the underestimation of the calculated risk for infection with HIV in sexual encounters, arising from nondisclosure of previous risk behavior or seropositivity)

The effects of nondisclosure of either HIV seropositivity or previous engagement in risk behavior on the estimation of risk in sexual intercourse is studied through the use of a probability model. Equations are utilized to derive an Underestimation Factor for three cases, which is shown to range from 2 to 20 in the case of insertive anal intercourse between an HIV+ and an HIV- man, and to 1 x 10(4) in a similar case of heterosexual insertive vaginal intercourse. This factor remains constant regardless of the number of sexual encounters between the same partners, and regardless of the protective measures as long as unawareness prevails. The discussion focuses on the implications of this formulation for education and social attitudes toward disclosure and nondisclosure in sexual encounters. It also raises the question of moral responsibility of sexual partners and some legal aspects of nondisclosure.