Sexual Health in the SARS-CoV-2 Era Turban, Jack L; Keuroghlian, Alex S; Mayer, Kenneth H
Annals of internal medicine,
09/2020, Letnik:
173, Številka:
5
Journal Article
To assess the performance of US health centers during the first year of required sexual orientation and gender identity (SOGI) data reporting and to estimate the baseline proportion of lesbian, gay, ...bisexual, and transgender patients accessing health centers.
We conducted a secondary analysis of SOGI data from 2016. These data were reported by 1367 US health centers caring for 25 860 296 patients in the United States and territories.
SOGI data were missing for 77.1% and 62.8% of patients, respectively. Among patients with data, 3.7% identified as lesbian, gay, bisexual, or something else; 0.4% identified as transgender male or female; 27.5% did not disclose their sexual orientation; and 9.3% did not disclose their gender identity.
Although health centers had a high percentage of missing SOGI data in the first year of reporting, among those with data, the percentages of lesbian, gay, bisexual, and transgender people were similar to national estimates, and disclosure was more than 70%. Future data collection efforts would benefit from increased training for health centers and improved messaging on the clinical benefits of SOGI data collection and reporting.
Managing fragile island freshwater resources requires identifying pumping strategies that trade off the financial cost of groundwater supply against controlling the seawater intrusion (SWI) ...associated with aquifer pumping. In this work, these tradeoffs are investigated through a sensitivity analysis conducted in the context of an optimization formulation of the groundwater management problem, which aims at minimizing the groundwater supply operation cost associated with groundwater pumping and desalination treatment, subject to constraints on SWI control, as quantified by the water table drawdown over the well (∆s), the reduction in freshwater volume (∆FV) in the aquifer, or the salt mass increase (∆SM) in the aquifer. This study focuses on a simplified two‐dimensional model of the San Salvador Island aquifer (Bahamas). Pumping strategies are characterized by the distance of the pumping system from the shoreline (WL), the ion screen depth (D) and overall pumping rate (Q), constituting the decision variables of the optimization problem. We investigate the impacts of pumping strategies on the operation cost, ∆s, ∆FV and ∆SM. Findings indicate increasing D or decreasing WL reduces ∆s, ∆FV and ∆SM, thus preserving the aquifer hydrogeologic stability, but also leads to extracting saltier groundwater, thus increasing the water treatment requirements, which have a strong impact on the overall groundwater supply cost. From a financial perspective, groundwater ion near the island center and at shallow depths seems the most convenient strategy. However, the analysis of the optimization constraints reveals that strategies where the pumping system approaches the island center tend to cause more severe SWI, highlighting the need to trade off groundwater supply cost against SWI control.
Key Points
Effects of pumping patterns (pump depth, rate and well location) on island groundwater supply cost and seawater intrusion (SWI) are studied
Shallow pumping near the island center is cost‐effective but causes more severe SWI, that is, a conflict between economic cost and SWI control
Controlling SWI by limiting water table drawdown usually leads to selecting more expensive groundwater supply strategies
To assess the performance of US federally qualified health centers (FQHCs) after 6 years of required sexual orientation and gender identity (SOGI) data reporting and update estimated proportions of ...sexual and gender minorities cared for at FQHCs.
We conducted secondary analyses of data reported to the 2020 and 2021 Uniform Data System from 1297 FQHCs caring for nearly 30 000 000 patients annually. We used multivariable logistic regression to explore FQHC-level and patient-level factors associated with SOGI data completeness.
SOGI data were missing for 29.1% and 24.0% of patients, respectively. Among patients with reported SOGI data, 3.5% identified as sexual minorities and 1.5% identified as gender minorities. Southern FQHCs and those caring for more low-income and Black patients were more likely to have above-average SOGI data completeness. Larger FQHCs were more likely to have below-average SOGI data completeness.
Substantial increases in SOGI data completeness at FQHCs over 6 years reflect the success of reporting mandates. Future research is needed to identify other patient-level and FQHC-level factors contributing to residual levels of SOGI data missingness. (
2023;113(8):883-892. https://doi.org/10.2105/AJPH.2023.307323).
•Wicked socio-ecological problems require transdisciplinary research approaches.•Most transdisciplinary research involves teams of academics and stakeholders.•We argue that forming transdisciplinary ...teams is a wicked problem.•Team formation exhibits characteristics identified by Rittel and Webber (1973).•We offer suggestions for managing the wicked team formation problem.
Transdisciplinary teams are called upon to research and resolve problems associated with socio-ecological systems, which are notoriously wicked. We propose that the formation of these teams is itself a wicked problem. We support this claim by identifying in transdisciplinary team formation characteristics from Rittel and Weber's (1973) list of wicked problem attributes. We recommend a set of strategies for managing the wickedness of team formation, drawn from our experience in forming teams to conduct research on socio-ecological systems and the team formation literature.
The aim of this study was to assess HIV preexposure prophylaxis (PrEP) provision in U.S. health centers.
The U.S. Ending the HIV Epidemic (EHE) initiative designated health centers as the main ...healthcare system through which PrEP scale-up occurs. Health centers offer primary care to over 30 million disproportionately uninsured, racially or ethnically minoritized, and low-income patients. This study is the first to assess PrEP provision across health centers, including characteristics of clinics, patient populations, and policies associated with PrEP prescribing.
The Health Resources and Services Administration's Uniform Data System contained aggregate data on PrEP prescriptions and patient sociodemographics at health centers from January 1 through December 31, 2021, in 50 U.S. states, the District of Columbia, and eight U.S. territories. We compared patient demographics and availability of Medicaid expansion and PrEP assistance programs at health centers that prescribed vs. those that did not prescribe PrEP.
Across 1375 health centers serving 30 193 278 patients, 79 163 patients were prescribed PrEP. Health centers that prescribed any PrEP had higher proportions of sexual, gender, racial, and ethnic minority patient populations compared with health centers that prescribed no PrEP. Compared with health centers that prescribed no PrEP, a higher proportion of health centers that prescribed PrEP were located in designated high-priority jurisdictions of the EHE initiative or states with Medicaid expansion or public PrEP assistance programs.
Health centers are critical for scaling up PrEP in minoritized populations disproportionately affected by HIV, facilitated through federal and state-level policies. These findings highlight service gaps and inform future interventions to optimize PrEP implementation and support EHE initiative goals.
According to the Human Rights Campaign, 77 anti-SGM bills had been signed into law as of June 8,2023, more than any previous year and double the number passed in the entire preceding year. Guidelines ...from the American Academy of Pediatrics have directed all pediatricians to create safe and inclusive environments for SGM patients.8 Fundamentally, collecting pediatric SOGI data ensures continued visibility of SGM youths and stands in opposition to ongoing legislative efforts to erase this population. ...a wealth of evidence has demonstrated that collection of SOGI data is critical for delivering responsive, affirming, and patient-centered care for SGM people.3 Knowledge of pediatric SOGI facilitates delivery of appropriate anticipatory counseling and referral to genderaffirming care and mental health supports. ...all EHRs used in pediatric care settings should have the capacity to collect SOGI data with standardized categories and terminology from current guidelines.11 This should also be paired with updating and integrating international code sets to capture patient SOGI data, such as the Systematized Nomenclature of Medicine and Logical Observation Identifiers Names and Codes.14 Standardization across EHRs should continue to align with DHHS interoperability standards and allow for performance benchmarking related to data collection efforts. ...training programs related to SOGI data collection should be delivered to all members ofthe health care workforce in pediatric care settings.
Introduction
Training in care for sexual and gender minority (SGM) populations is critical for ending the HIV epidemic. SGM people, particularly men who have sex with men (MSM) and transgender women, ...experience disproportionate HIV infection across the globe. The objective of this commentary was to synthesize facilitators of and barriers to SGM health training efforts for healthcare workers in Uganda, in order to help inform potential priorities, strategies and next steps to advance culturally responsive HIV‐related care for SGM communities across Uganda and sub‐Saharan Africa.
Discussion
SGM health training often includes education on: foundational concepts and language; stigma, discrimination and SGM health disparities; understanding and addressing implicit bias; sensitive and effective communication and building SGM‐inclusive and welcoming healthcare environments. Clinicians’ education includes sexual and gender histories, sex‐positive HIV counselling, sexually transmitted infections, HIV pre‐exposure prophylaxis and gender‐affirming hormone therapy. SGM communities in sub‐Saharan Africa have often experienced discrimination, persecution, incarceration and physical violence, and they encounter unique barriers to engagement in sexual health services and HIV prevention and treatment. SGM health training efforts in Uganda reveal challenges to and opportunities for advancing equity for SGM communities in sexual health and HIV medical care across the region. In Uganda, SGM community advocacy, as well as policies and programmes of the Ministry of Health and US President’s Emergency Plan for AIDS Relief, have increased readiness and need for scaling up training and skills‐sharing in SGM‐focused HIV and sexual healthcare, including Ugandan‐led and international initiatives.
Conclusions
Numerous challenges exist to widespread culturally responsive HIV and sexual healthcare for SGM communities in sub‐Saharan Africa. Lessons learned from healthcare worker training efforts in Uganda may inform future replication, adaptation and dissemination initiatives to meet the needs of more SGM communities in the region. Evaluation of SGM health training programmes to determine the impact on HIV virological suppression and sexual health outcomes will be critical for identifying best practices and strategies that may support advancing HIV epidemic control for SGM communities in Uganda and across sub‐Saharan Africa.
Transgender and gender diverse (TGD) populations experience health disparities due to societal stigma that increases TGD individuals' sources of stress and decreases access to health protective ...resources. Research has linked experiences of stigma to risky alcohol use, yet there remains a dearth of culturally sensitive alcohol use interventions that meet the needs of TGD people. The present study was conducted to inform modifications to the content and delivery of an existing brief, telehealth, motivational intervention to decrease at-risk alcohol use among TGD adults. Individual semi-structured in-depth qualitative interviews were conducted with TGD adults who reported recent alcohol use (n = 18) to explore factors that facilitate positive interactions with health care providers and identify relevant information for alcohol use disorder treatment. Participants were recruited from an LGBTQ+-focused health center in Los Angeles, California. Two major themes and recommendations emerged: (a) A multicultural orientation of humility is important to develop productive therapeutic relationships with TGD clients when delivering motivational interviewing; (b) Due to insufficient appropriate data on alcohol use and health in TGD populations, feedback used in motivational alcohol counseling needs to be modified to better serve TGD clients. These findings show that counselors' philosophy and behavior, as well as session content, need to be considered when working with TGD populations within the context of alcohol counseling. These findings also have implications for intervention development, clinical treatment, and future research.
Public Policy Relevance Statement
Given the lack of guidelines for delivering alcohol interventions with transgender and gender diverse (TGD) populations, it is important to ask community members how to address current gaps. Results of qualitative interviews highlight the importance of cultural humility and provide guidance on how to modify normative feedback and discussion of low-risk drinking guidelines when delivering alcohol counseling to TGD adults.
This study identified barriers and facilitators associated with providing culturally responsive care for sexual and gender minority (SGM) patients at federally qualified health centers (FQHCs) in the ...United States, from the perspective of clinical leadership.
Between July and December 2018, 23 semistructured, in-depth qualitative interviews were held with clinical leaders representing six FQHCs residing in rural and urban settings. Stakeholders included Chief Executive Officer, Executive Director, Chief Medical Officer, Medical Director, Clinic Site Director, and Nurse Manager positions. Interview transcripts were analyzed using inductive thematic analysis.
Barriers included personnel factors related to lack of training and fear, competing priorities, and environments that focused on treating all patients similarly. Facilitators included established partnerships with external organizations, staff with prior SGM training and knowledge, and active initiatives in clinic settings targeting SGM care.
Clinical leadership expressed strong support for evolving their FQHCs into organizations that provide culturally responsive care for their SGM patients. FQHC staff across all levels of clinical care would benefit from regularly occurring training sessions on culturally responsive care for SGM patients. To ensure sustainability, improve staff buy-in, and mitigate the impact of staff turnover, improving culturally competent care for SGM patients should be a shared goal and responsibility for leadership, medical providers, and administrative staff.
NCT03554785.
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