Aim
To review current research on lesbian, gay, and bisexual (LGB) individuals' experience of nursing services from an emancipatory nursing practice framework.
Background
As LGB issues are ...marginalized in health care, it is important to understand LGB individuals' experiences of nursing.
Design
An integrative literature review using critical analysis based on an emancipatory nursing practice framework was conducted.
Data sources
A search of all English nursing journals in the World of Science database was conducted.
Review methods
Established methods were used to search, identify, and appraise articles meeting the criteria of examining LGB individuals' experiences of nursing services, published in the years 2009 to 2015. Sixteen articles that met the inclusion criteria were identified independently by the two authors. Data were analysed using descriptive and critical phases of enquiry.
Results
Results show a nexus of experiences of exclusion and oppressive social norms. Our analytical framework highlighted absences in nursing practice. No research indicates that LGB people experience nurses as advocates or participatory health care processes.
Conclusion
Standards, training, and systems need to be devised that ensure inclusionary nursing practices, that encourage nurses to act as advocates for LGB health care justice, and that allow LGB individual to participate in the development of health care policies and procedures.
SUMMARY STATEMENT
What is already known about this topic?
Lesbian, gay, and bisexual (LGB) people's needs are often not considered in nursing practice leading to far‐reaching consequences such as discrimination, misdirected treatment, and LGB people failing to access the care that they need.
What this paper adds?
Using an emancipatory nursing framework to analyse nursing literature, exclusions and oppressions of LGB people are highlighted, as well as ways in which nursing practice could, but does not, forward health justice for LGB people.
The implications of this paper:
Other than undermining exclusionary and oppressive practices, it is necessary for the nursing profession to take on advocacy roles and to engage in participatory processes to ensure health justice for LGB individuals.
Abstract
Background
In Kenya, South Africa, and Zimbabwe, oral pre-exposure prophylaxis (PrEP) is recommended for adolescent girls and young women (AGYW) at high risk of HIV. Health providers play a ...critical role in the uptake and effective use of sexual and reproductive health services; however, few published studies have explored providers’ attitudes toward and experiences delivering PrEP to AGYW.
Methods
We conducted a cross-sectional qualitative study, interviewing 113 providers at 36 public, private, and nongovernmental health facilities in Kenya, South Africa, and Zimbabwe that were offering PrEP during the research period or were likely to offer PrEP in the future. Data were coded in NVivo 11, and an applied thematic analysis was conducted.
Results
Most providers preferred that adolescent girls wait until age 18 to have sex but acknowledged that many girls younger than 18 could benefit from oral PrEP. Their primary concern was whether adolescent girls would be able to take PrEP daily, especially if they do not tell their parents or partners they are using it. Providers reported that it was more challenging to deliver PrEP and other HIV services to girls younger than 18. Those with experience providing PrEP pointed to stigma and lack of PrEP awareness in communities as two primary barriers to PrEP uptake and use.
Conclusions
Providers were generally accepting of oral PrEP as an HIV prevention option for AGYW; however, many had negative attitudes about adolescent girls being sexually active and concerns about whether they could take PrEP daily. Results were used to update national PrEP training materials to address negative provider attitudes about PrEP use by AGYW.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Nurses play a key role in the provision of services in relation to sexuality in both primary and sexual and reproductive health‐care. Given the intersection of sexualities with a range of social ...injustices, this study reviews research on nursing practice concerning sexuality from an emancipatory/social justice perspective. A systematic review of English articles published in nursing journals appearing on the Web of Science database from 2009 to 2014 was conducted. Thirty‐eight articles met the inclusion criteria. Analysis consisted of a descriptive phase (types and location of studies, aspects of sexualities focused on, target health users and aspects of nursing practice focused on) and a critical/emancipatory phase. In terms of practice, our analysis revealed that: barriers exist to the integration of issues relating to sexuality in nursing practice; the social location of nurses and their personal feelings regarding sexuality influence their practice; content that addresses gendered norms and media that assist in communication underpin some emancipatory practices. Few studies locate analyses of nursing practice within gendered, cultural and social norms; consider advocacy as part of the practice of nurses; or analyse the promotion of health user participation in health services and structures. The implications for emancipatory practice are drawn out.
Against the backdrop of the healthcare inequities and maltreatment facing LGBT patients, recommendations have been made for the inclusion of LGBT health topics in nursing curricula. Based on data ...collected in focus group discussions with South African nursing students, we complicate the assumption that training focused on health-specific knowledge will effectively reform providers' prejudicial practices. Findings reveal ambivalence: silence and discrimination versus inclusive humanism. Participants drew on discourses of ignorance, religion, and egalitarian treatment to justify their inadequacy regarding LGBT patients; while doing so, however, they deployed othering discourses in which homophobic and transphobic disregard is rendered acceptable, and "scientifically" supported through binary, deterministic views of sexuality and gender. Such "expert" views accord with Foucault's notion of "grotesque discourse." We conclude with a discussion of the findings' implications for nursing education; we call for the recognition and teaching of binary ideology as a form of discursive violence over LGBT lives.
Limited antimicrobial resistance (AMR) surveillance coupled with syndromic management of sexually transmitted infections (STIs) in sub-Saharan Africa (SSA) could be contributing to an increase in AMR ...in the region. This systematic review aimed to synthesize data on the prevalence of AMR in common STIs in SSA and identify some research gaps that exist.
We searched three electronic databases for studies published between 1 January 2000 and 26 May 2020. We screened the titles and abstracts for studies that potentially contained data on AMR in SSA. Then we reviewed the full text of these studies to identify articles that reported data on the prevalence of AMR in Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and Mycoplasma genitalium in SSA. We summarized the data using a narrative synthesis.
The 40 included studies reported on AMR data from 7961 N. gonorrhoeae isolates from 15 countries in SSA and 350 M. genitalium specimens from South Africa. All four SSA regions reported very high rates of ciprofloxacin, tetracycline and penicillin resistance in N. gonorrhoeae. Resistance to cefixime or ceftriaxone was observed in all regions except West Africa. Azithromycin resistance, recommended as part of dual therapy with an extended-spectrum cephalosporin for gonorrhoea, was reported in all the regions. Both macrolide and fluoroquinolone-associated resistance were reported in M. genitalium in South Africa. Studies investigating AMR in C. trachomatis and T. vaginalis were not identified.
There is a need to strengthen AMR surveillance in SSA for prompt investigation and notification of drug resistance in STIs.
Despite strengthening HIV prevention with the introduction of pre-exposure prophylaxis (PrEP), STI services have remained relatively unchanged and the standard of care remains syndromic management. ...We used a discrete choice experiment to investigate service users' preferences for the diagnosis and treatment of STIs in South Africa.
Between 1 March 2021 and 20 April 2021, a cross-sectional online questionnaire hosted on REDCap was administered through access links sent to WhatsApp support groups for HIV PrEP users and attendees of two primary healthcare clinics and two mobile facilities in the Eastern Cape and Gauteng provinces aged between 18 and 49 years. Participants either self-completed the questionnaire or received support from a research assistant. We used a conditional logit model for the initial analysis and latent class model (LCM) to establish class memberships, with results displayed as ORs and probabilities.
We enrolled 496 individuals; the majority were female (69%) and <30 years (74%). The LCM showed two distinct groups. The first group, comprising 68% of the participants, showed a strong preference for self-sampling compared with no sampling (OR 2.16, 95% CI 1.62 to 2.88). A clinic follow-up appointment for treatment was less preferable to same-day treatment (OR 0.78, 95% CI 0.63 to 0.95). Contact slip from index patient (OR 0.86, 95% CI 0.76 to 0.96) and healthcare professional (HCP)-initiated partner notification (OR 0.63, 95% CI 0.55 to 0.73) were both less preferable than expedited partner treatment (EPT). The second group included 32% of participants with a lower preference for self-sampling compared with no sampling (OR 0.65, 95% CI 0.41 to 1.04). There was no treatment option that was significantly different from the others; however, there was a strong preference for HCP-initiated partner notification to EPT (OR 1.53, 95% CI 1.10 to 2.12).
Our results suggest that service users preferred STI testing prior to treatment, with the majority preferring self-taken samples and receiving aetiology-based treatment on the same day.
Background Since 2009, global efforts have made significant strides in identifying and treating People Living with HIV (PLHIV), with the number on Antiretroviral Therapy (ART) surpassing 25 million ...by 2020. However, challenges persist as a substantial number of individuals enrolled in ART, particularly in countries like Zimbabwe and Malawi, are lost to follow-up, impeding the success of HIV response initiatives. Stigma and limited awareness continue to pose barriers to effective HIV management. Methods The methodology centres on identifying compelling messengers to bridge the gap between medical information and lived experiences in sub-Saharan Africa. Grounded in human-centered and co-design approaches, the initiative engages host country governments, stakeholders, influencers, and the target audience to create a globally resonant brand with country-specific adaptations. Results The "Undetectable = Untransmittable" (U=U) movement, founded in 2016, emphasizes that PLHIV with undetectable viral loads cannot transmit the virus, playing a crucial role in dismantling stigma and enhancing HIV prevention efforts. To address the low awareness of U=U in Malawi and Zimbabwe, the collaborative "Flip the Script" project was launched, involving public and various private sectors. This initiative aims to reshape perceptions around ART, presenting it as a key to a normalized, healthy life rather than a symbol of infection. "Flip the Script" seeks to boost ART initiation and re-initiation, promote effective ART use, and encourage viral load testing and result sharing among PLHIV. It also strives for consistent counseling on the prevention benefits of ART by health providers. Conclusions Ultimately, the initiative aims to increase the percentage of PLHIV achieving and sustaining viral suppression, leading to a reduction in HIV incidence. Its success hinges on effectively communicating the U=U message, challenging stigma, and empowering both PLHIV and health providers in the targeted regions.
Stigmatising attitudes towards people living with HIV and AIDS (PLHIV) are hampering attempts to control HIV epidemics in sub-Saharan African countries. This study measures the effect of social ...capital, in the form of local community groups, in reducing stigma and tests a new explanatory framework for the association between community group membership and less stigmatising attitudes. Prospective data on membership of a wide range of different community groups and stigmatising attitudes (being unwilling to care for a relative with AIDS), collected from a general population cohort of 5,253 men and women aged 15–54 years in eastern Zimbabwe between 2003 and 2008 were analysed using multivariable logistic regression. 36 % of respondents were members of community groups throughout the study period. Individuals in community groups were less likely to express stigmatising attitudes towards PLHIV—3.4 versus 9.5 % (adjusted odds ratio = 0.46, p < 0.001). Discussions of care for PLHIV within groups, improved knowledge about AIDS, greater exposure to PLHIV, and increased uptake of HIV testing and counselling did not account for the association. Further work is needed to identify the mechanisms through which community participation can reduce stigma. Nevertheless, these findings suggest that promoting well-informed discussions about HIV within pre-existing community groups and involving these groups in stigma reduction programmes could be effective means of reducing stigma at the grassroots level.
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