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While studies have explored how health sector corruption, weak healthcare system, large-scale immune compromised population, misinformation and prevalence of highly congested slums contribute to the spread of COVID-19 in Nigeria, they have glossed over the impact of political distrust on the spread of the virus. This study explores the impact of political distrust on the spread of COVID-19 pandemic in Nigeria. The study utilised qualitative dominant mixed methods approach comprising telephone interviews and a survey of 120 educated Nigerians purposively selected from four COVID-19 most affected states including Lagos, Oyo, Kano and Rivers as well as the Federal Capital Territory, Abuja. The study also relied on secondary data on the spread of COVID-19 in Nigeria sourced from Nigeria Centre for Diseases Control from 27 February to 31st August 2020. The study found that political corruption motivates large-scale political distrust. This undermines public compliance to government protocols, limits the outcomes of government responses to COVID-19 and facilitates the spread of the virus in Nigeria. The paper concludes that improving government accountability in the public sector management is relevant for building public trust, promoting citizens' compliance to COVID-19 safety measure and mitigating the spread of the pandemic in Nigeria and beyond. [ABSTRACT FROM AUTHOR]

The suicide rates officially reported by most countries are widely believed to be lower than actual rates, attributable partly to inaccuracy of registration of deaths and misclassification of cause of death. In this review paper, we discuss under-counting of deaths and of suicides, referring to findings from international research. We then describe the three main ICD-10 cause of death categories that possibly harbour 'hidden suicides': ill-defined or unknown causes of death, events of undetermined intent (EUI), and accidental deaths. We used the 2017 Australian mortality statistics to illustrate these three categories. The World Health Organization (WHO) data and international research show (1) that mortality data provided to the WHO by a large number of its Member States are of questionable quality and not timely; and (2) substantial variations among countries in rates of suicide, ill-defined or unknown deaths, EUIs, and accidental deaths (notably, poisoning). Accurate reporting of suicides is needed to advance research on suicide prevention and develop more effective suicide prevention programmes. Nations should endeavor to obtain, publish and analyse data regarding annual rates of deaths coded as of ill-defined/unknown cause, EUI, and accidental poisoning and other relevant types of accident. [ABSTRACT FROM AUTHOR]

The major challenges in controlling the Ebola Virus Disease (EVD) outbreak in Guinea were contact tracing, referral of suspected cases, secure burial and mistrust in the context of a weak health system. Community involvement and uptake of key interventions were very low, contributing to the spread of the epidemic. A community engagement project, using community based organisations (CBOs) and community leaders, was implemented in four affected health districts in rural Guinea. This paper reports on the contribution of the CBOs and community leaders in controlling the EVD outbreak. Base-, mid- and end – line assessments were conducted using a mixed methods approach. In total, 422 CBOs members, 50 community leaders and 40 village birth attendants were engaged in social mobilisation, awareness raising, reaching 154,310 people and leading to the end of reluctance and mistrust. Thus, 95 suspected cases were referred to health facilities, contact tracing and secure burial increased from 88.0% to 96.6% and from 67% to 95.4%, respectively, and institutional deliveries increased from 637 to 806. Involvement of CBOs and community leaders against the EVD outbreak is an effective resource that should also be considered to better respond to possible large-scale epidemic threats in a fragile health system context. [ABSTRACT FROM AUTHOR]

To reach the most vulnerable individuals in under-resourced countries, health communication interventions increasingly move towards the community level. However, little is known about how health information spreads through local social networks. This paper maps the health information network of a rural trading centre in Uganda. As part of a five-year ethnographic study of sustainable community health resources, ego networks were obtained for 231 village residents in March 2014. Using both ethnographic and social network data, we analyze how the village social network is structured, and how this structure may influence the transmission of health information. Results show a network with low average proximity, with a small number of individuals, notably key administrative officials, much closer connected to many other community members than average. However, because of social partitioning in the village network, a number of people are outside the social clusters in which the top influencers are located. [ABSTRACT FROM AUTHOR]

Informal settlements remain a public health problem as they lack basic infrastructure. Furthermore, it is challenging to enforce public health regulations and protocols to prevent the spread of infection during a pandemic. This paper was set out to explore the impact of lockdown during COVID-19 among people living in informal settlements. An exploratory qualitative design was utilised. Purposive sampling was used to select research participants. In-depth one-to-one interviews were held involving 30 research participants through a WhatsApp online telephone platform. A thematic approach underpinned by the four stages of data analysis in interpretive phenomenological analysis was utilised to analyse the data. The study found that during the the research participants were affected by lack of space to practice social distancing, over-burdened infrastructure, lack of savings, loss of income and shortage of food, hunger and diseases, anxiety and depression and poor access to education. There is a need to prioritise the needs of informal settlers and endeavour to establish permanent homes. Health promotion and communication initiatives and pandemic awareness programmes are needed to mitigate the impact of lockdown during a pandemic in informal settlements. [ABSTRACT FROM AUTHOR]

While COVID-19 has become a global pandemic that has spread to all regions of the globe, local historic, health, and socio-environmental factors shape the epidemiological contours, response, and social challenges present within each affected nation. Thus, while countries like China, Italy, Iran, Brazil, and the United States have all been hard hit by the pandemic, there are critical differences across these nations in a number of variables (e.g. demographic features, health histories, healthcare systems, infection case rates, case fatality rates, national responses). In other words, within the global pandemic there are multiple importantly distinct national epidemics. Overcoming the grave threats to public health presented by COVID-19 requires both international cooperation and country-specific efforts that reflect local histories, needs, and resources. Already concerns are being expressed among health officials about how COVID-19 might be devastating in Africa. Currently, South Africa has the highest number of diagnosed COVID-19 cases on the continent and has been identified as being at high risk in the pandemic. This paper examines the public health response to the COVID-19 threat, how the prior and ongoing HIV and TB epidemics shape the COVID-19 epidemic and influence the response, and the potential ramifications of the response. [ABSTRACT FROM AUTHOR]

In seeking to limit the number of new infections of COVID-19, governments around the world have implemented national lockdowns and guidelines about safe behaviours. Lockdown requires people to stay home and only leave when essential such as to purchase groceries and medication. In low- and middle-income countries, many of which have large proportions of the population living in precarity, lockdown forces millions of people to spend prolonged periods of time together in close proximity to one another and with limited resources. In many ways, efforts to contain the spread of COVID-19 in densely populated communities with limited access to food, water and sanitation may seem counter-intuitive and even impossible under conditions of precarity. In this paper, we explore the barriers to implementation of lockdown rules in conditions of precarity. We conceptualise the structural barriers by drawing on the Theoretical Domains Framework to explain how these barriers influence adherence to lockdown rules. We argue that without sufficient support or intervention to help poor communities mitigate these structural barriers, adhering to lockdown rules is difficult, resulting in continued COVID-19 infections. [ABSTRACT FROM AUTHOR]

The Global Forum for Health Research (GFHR) was founded in 1998. It was the culmination of an advocacy movement started in 1987 to campaign for the expansion and coordination of health research benefitting low- and middle-income countries. It was largely funded by the World Bank and embraced that institution's emphasis on cost effectiveness. But its small budget prevented it from assuming the central role in global health research that its supporters had envisaged. It took on more modest tasks, focusing on advocacy, organising an annual conference and monitoring research funding. In 2010, it was absorbed amid general indifference by another small organization, the Council on Health Research for Development (COHRED) and eventually disappeared from sight. We argue in this paper that its fate had two major causes. First, it resulted from operational and budgetary problem and its inability to attract the new money that was pouring into Global Health (GH). Second, it reflected the aggressive efforts by the WHO to reclaim leadership in this domain. Underlying this failure, however, was the inherent difficulty of coordinating the ideologically fragmented and individualistically oriented GH research domain. [ABSTRACT FROM AUTHOR]

For the past several decades, global health research and policy have raised the alarm about the growing threat of counterfeit and low-quality drugs (henceforth 'fakes'). These high-profile and regularly-repeated claims about 'fake drugs' pepper scholarly publications, grey literature, and popular writing. We reviewed much of this work and found that it shares two characteristics that sit awkwardly alongside one another. First, it asserts that fake drugs constitute an urgent threat to lives. Second, it reports trouble with 'gaps' in the evidence on which their claims are based; that data is weaker and less conclusive than anticipated. Given the ubiquity of and urgency with these claims are made, we found this juxtaposition perplexing. To understand this juxtaposition better, we undertook a close reading of the strategies authors employed to negotiate and overcome data and evidence 'gaps' and asked questions about the cultures of scholarly publishing in global health research. We argue that a scholarly commitment to studying fakes despite--rather than because of—the evidence functions to support the continuation of similar research. It also works against asking different questions—for instance regarding the lack of easy access to pharmacological data that might make it possible to know fakes differently. [ABSTRACT FROM AUTHOR]

As originally conceived, syndemics refers to complex epidemics involving two types of adverse interaction – the clustering and interactions of two or more diseases or health conditions (the biological–biological interface) and social environmental factors (the biological–social interface). The theory has been widely applied in the fields of medicine, public health and anthropology, but how the concept is conceptualised and investigated in new syndemics literature remains unclear. This paper offers a scoping review of recent syndemics literature aiming to address the question: Where have scholars taken the syndemics concept? Five bibliographic databases were searched for titles containing 'syndemic[s]' revealing 334 records. A total of 143 journal articles, 23 book chapters, 21 commentaries, 2 books and 5 dissertations were assessed. Citations were classified into five categories: syndemics (n = 22), potential syndemics (n = 34), socially determined heightened burden of disease (n = 29), harmful disease cluster (n = 32) and additive adverse conditions (n = 71). The limited number of citations meeting the definition of a syndemic arrangement highlights the challenges related to describing and empirically supporting the biological–biological and biological–social relationships. Nevertheless, there is value in retaining the original, holistic, biosocial meaning of syndemics to identify and detail the casual pathways and mechanisms of interactions. [ABSTRACT FROM AUTHOR]

Leprosy stigma is more neglected than the disease itself since global interventions towards leprosy are focused on the medicalisation of individual-sufferers and statistical counting of documented cases and less prioritising the impact of leprosy stigma towards society. This paper examines the impact of courtesy stigma on society through comparative ethnographic method conducted in two sites in East Java Province, Indonesia. Investigation in the first site, Mandangin Island, found that the island suffers underdevelopment of public facilities such as clinics and clean water and migration and medical knowledge bottlenecks. In the second site, Sumberglagah village, leprosy patients and the community they live with are also socially separated from the locals and they are engaged in controversial businesses exploiting the public fear of leprosy. This study finds that leprosy stigma in two leprosy-impacted communities in East Java, Indonesia, does not only isolate individuals but also a whole community from a bigger society regardless of whether all of the community members have leprosy. This study also detects problems related to leprosy education within the two impacted communities. It is suggested that efforts to address the problems require holistic approaches and commitments from various actors in the area in complement to existing global health missions. [ABSTRACT FROM AUTHOR]

Overall, adult men are less likely to seek and receive health care than women, but male circumcision for HIV prevention has been successful in engaging men in health services. The purpose of this paper is to examine the relationship between masculine norms and health care-seeking among men participating in a voluntary male medical circumcision (VMMC) programme in the Dominican Republic (DR). We employed a mixed methods approach integrating survey data collected 6–12 months post-circumcision (n = 293) and in-depth interviews with a sub-sample of these men (n = 30). In our qualitative analysis, we found that health care-seeking is connected to masculine norms among men in the DR, including the perceptions of medical facilities as feminine spaces. Participants' narratives demonstrate that male circumcision programmes may facilitate men overcoming masculinity-related barriers to health care engagement. In quantitative analysis, we found that being concerned about being perceived as masculine was associated with health care-seeking behaviour in the past five years, though this association was not retained in multivariable analyses. Findings indicate that male circumcision programmes can familiarise men with the healthcare system and masculinise health care-seeking and utilisation, easing associated discomfort. [ABSTRACT FROM AUTHOR]

In one rural community in Yucatán, many residents express concerns about the disruption alcohol use poses to the calm of everyday life and the wellbeing of individuals, families, and society. At the same time, men who drink point to tangible ways in which alcohol consumption relieves them of suffering and brings pleasure. Aware of the often-negative effects of their drinking, these men root their desire to get drunk in structural inequalities and resultant stress. Through analysis of extended ethnographic research, this paper explores drinking as a practice through which the complex and sometimes contradictory nature of care in modern life in rural Yucatán is exposed. Care through and against alcohol consumption reveals a convergence of suffering and privilege, one that is, in some ways, uniquely local and, in other ways, reflective of working-class masculinity in many parts of the world. [ABSTRACT FROM AUTHOR]

Decision-making regarding the outcome of a pregnancy may include participation of the woman herself, her sexual partner, parents, family, and/or community. This paper examines who had the most say in the outcome of young Ghanaian women's last pregnancy and whether this correlated with her level of reproductive autonomy (RA). We analysed cross-sectional data from 380 previously pregnant young women in urban Ghana. We measured communication and decision-making RA using modified scales ranging from 3 (low RA) to 12 (high RA). We tested unadjusted associations between the RA sub-scales and who made the pregnancy decision (self, partner, both together, or someone else) and used multinomial regression models to understand these associations when controlling for sociodemographic, reproductive history, and social context variables. In final models, a one-point increase in decision-making RA was associated with an adjusted relative risk ratio of 0.79 (95% CI: 0.66–0.93; p = 0.006) of partner having the most say as compared to the woman having the most say. The communication RA scale was not associated. Programmes that increase RA may be effective in increasing women's rights to execute decisions about reproductive health and outcomes. Future research should explore this notion and the role of pregnancy disclosure in this relationship. [ABSTRACT FROM AUTHOR]

Access to electricity is an important issue in low- and middle-income countries (LMICs) however its health implications are poorly understood. This paper systematically reviews the health effects of access to electricity and develops a conceptual model to summarise the pathways through which these effects may occur. The databases CINAHL, Embase, and MEDLINE were searched for studies examining the effects of access to electricity on health in LMICs. Thirty-three studies met the inclusion criteria: 23 focusing on electrification and 10 focusing on electricity reliability. Using a modified socio-ecological model, 4 main levels of influence were identified: (1) individual, (2) household, (3) community, and (4) institutional. Electrification was generally associated with positive health outcomes, such as reduced mortality, lower rates of disease, and improved quality of and access to care, while poor electricity reliability was associated with negative health outcomes, including increased morbidity and mortality, lower quality of care, and reduced utilisation of health services. Although the overall quality of the evidence was weak, given the many potential pathways through which electricity may affect health, efforts should be made not only to increase the number of connected households globally, but to improve the reliability of the electricity supply as well. [ABSTRACT FROM AUTHOR]

Various factors have been implicated in vaccine hesitancy and loss of vaccine confidence, but the specific ways and particular moments in which immunisation programmes and vaccine scares are politicised, exacerbating negative attitudes about vaccines and leading to retrogressive policies, have been relatively under-examined. This paper applies the concept of 'medical populism' [Lasco, G., & Curato, N. (2019). Medical populism. Social Science & Medicine, 221(1), 1–8. doi:10.1016/j.socscimed.2018.12.006] to examine these under-studied dynamics, looking at political actors and how they 'construct antagonistic relations between "the people" whose lives have been put at risk by "the establishment"' in the performance of vaccine-related crises. Four illustrative cases – from Nigeria, Italy, Ukraine, and the Philippines – are presented to demonstrate the descriptive and analytic value of medical populism beyond the framing and characterisation of the politics of health. The study underscores the need to understand people's perceptions and 'explanatory models' of vaccines and vaccine failures, to look at the political milieux that underpin immunisation programmes, and to anticipate and address knowledge claims made by political actors. [ABSTRACT FROM AUTHOR]

Chronic conditions are an increasing problem in Low- and Middle-Income Countries (LMICs) yet, the challenges faced by low-income populations with these conditions in such countries are not well understood. Based on in-depth interviews with people affected by chronic conditions and their family members, this paper describes the experience of patients suffering from diabetes or hypertension in rural communities of Mozambique, Nepal, and Peru. We analysed our data using the concepts of disruption and adaptive strategies, finding that despite being very different countries, the implications in daily lives, interpersonal relationships, and family dynamics are similar, and that oftentimes such impact is defined along gender lines. We show that adjustments to living with a chronic disease are not always easy, particularly when they imply changes and reconfiguration of roles and responsibilities for which neither the individual nor their families are prepared. The study adds to the literature on the disruptive effects of chronic conditions and stresses the importance of contextualising disruptive experiences among disadvantaged populations within weak health systems. Our findings highlight the relevance of understanding the challenges of developing adaptive solutions to chronic care in resource-scarce contexts. [ABSTRACT FROM AUTHOR]

The trade in health services for foreign patients, often termed 'medical tourism' or medical travel, is a growing industry being aggressively marketed across Asia. This paper explores the industry development in four countries: Thailand, India, Malaysia, and Singapore, providing a preliminary review of the political economy of the industry, marketing strategies, and linkages. As yet, there has been neither academic work considering the implications of this trade for public health, nor studies on the medical travellers themselves and their experiences. The final part of this paper contemplates some of the implications for public health in the region, and the ethical issues this globalized trade presents. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to present an analysis of how issues on sexuality are captured by the World Bank's economic rationality, producing a sanitised discourse which, through its silences, further contributes to a normalised view of sexuality. Given the Bank's authority to determine what kinds of health and development programmes are established in the developing world, it is in a unique position to influence approaches to issues of gender and sexuality. An analysis of the Bank's documents reveals, however, that rather than addressing these fundamental components of some of the most pressing health emergencies of our time, its economic rationality and technocratic viewpoint has effectively silenced and sanitised the discourse on sexuality, thereby limiting what sexuality and gender-related issues can be tackled in the context of Bank sponsored programmes, and constraining efforts to advance fundamental sexual rights. Nevertheless, unexpected and paradoxical results may arise from that process, which, thus, does not necessarily lead to the furthering of a comprehensive conservative agenda. [ABSTRACT FROM AUTHOR]

This paper reviews published literature on experiences in mainstreaming gender within the health sector since the 1990s. Although much has been written about the need for mainstreaming gender, and on how to go about it, the gap between intention and practice is palpable. National health policies and programmes that have gender integrally woven into their objectives and activities are rare. Health research to generate gender and sex-specific data, and integrating gender in health provider training, have received scarce attention. Mainstreaming gender within institutions has remained superficial, investing more on form than on content. The apparent lack of progress in mainstreaming gender in health may be attributed to: depoliticization and delinking of gender mainstreaming from social transformation and social justice agendas; adoption of top-down approaches to mainstreaming; growing hostility within the global policy environment to justice and equity concerns; and increasing privatization and retraction of the state's role in health. This paper suggests that the way forward would be to frame gender concerns in the language of equity, rights, and justice; to set agendas which consider gender inequity within the context of inequities by caste, class, ethnicity, and other sources of health inequalities; and to work alongside other movements for social justice. [ABSTRACT FROM AUTHOR]

This paper is concerned with how sex chromosomes and gendered experience differentially contribute to health outcomes, and how gender effects provide an under-explored avenue for health intervention. Research on gender and health is currently undermined by conflation of sex and gender in much of the epidemiologic and clinical literature. This precludes any meaningful reflection on the extent to which our genetic blueprint, versus gendered socialization, contributes to the specific health vulnerabilities of males or females. Drawing on the 2002 global disability adjusted life years (DALYs) for males and females, this paper looks at health outcomes that differentially affect males and females, and distinguishes between vulnerabilities linked to the XX or XY genotype, vulnerabilities due to gendered life experience, and vulnerabilities about which we understand relatively little. The paper highlights the dynamic and changeable nature of gendered health vulnerabilities. Given that gender-based risks are, in principle, amenable to social change, they offer untapped potential for health interventions. [ABSTRACT FROM AUTHOR]

While the topic of women and water, sanitation and hygiene is a widely accepted concern among academics and activists, it continues to be an issue in developing countries with serious consequences. Based on a qualitative research conducted in rural Uttar Pradesh, India, the paper affirms that sanitation issues for women and girls are compounded by inequitable gender norms that put them at greater risk of experiencing violence and multiple health vulnerabilities. Women, despite having a high demand for safe toilet facilities, continue to practise unsafe sanitation. The findings highlight the role of three structural constraints as the key factors influencing toilet construction and use: poverty, inadequate sanitation policy and its implementation and gender-based power dynamics at the household level. The paper concludes by emphasising the relevance of engendering sanitation programmes and policies by involving women and girls in the planning process to ensure that dignified and gender-sensitive sanitation solutions are developed. The paper also stresses the need to have measures for strengthening and effectively implementing a sanitation policy for the poor and for programmes to work with both men and women to address gender power relations which influence toilet adoption and use. [ABSTRACT FROM AUTHOR]

MISM (i.e. men who use the Internet to seek sex with men) has emerged in public health literature as a population in need of HIV prevention. In this paper, we argue for the importance of rethinking the dominant notions of the MISM category to uncover its ethnocentric and heteronormative bias. To accomplish this, we conducted a historical, epistemological and transnational analysis of social sciences and health research literature (n = 146) published on MISM between 2000 and 2014. We critically unravel the normative underpinnings of ‘westernised’ knowledge upon which the MISM category is based. We argue that the essentialist approach of Western scholarship can homogenise MISM by narrowly referring to behavioural aspects of sexuality, thereby rendering multiple sexualities/desires invisible. Furthermore, we argue that a Eurocentric bias, which underlies the MISM category, may hinder our awareness of the transnational dynamics of sexual minority communities, identities, histories and cultures. We propose the conceptualisation of MISM as hybrid cultural subjects that go beyond transnational and social boundaries, and generate conclusions about the future of the MISM category for HIV prevention and health promotion. [ABSTRACT FROM AUTHOR]

Photovoice methodology is growing in popularity in the health, education and social sciences as a research tool based on the core values of community-based participatory research. Most photovoice projects state a claim to the third goal of photovoice: to reach policy-makers or effect policy change. This paper examines the concerns of raising false hopes or unrealistic expectations amongst the participants of photovoice projects as they are positioned to be the champions for social change in their communities. The impetus for social change seems to lie in the hands of those most affected by the issue. This drive behind collective social action forms, what could be termed, a micro-social movement or comparative interest group. Looking to the potential use of social movement theory and resource mobilisation concepts, this paper poses a series of unanswered questions about the ethics of photovoice projects. The ethical concern centres on the focus of policy change as a key initiative; yet, most projects remain vague about the implementation and outcomes of this focus. [ABSTRACT FROM AUTHOR]

In this paper, we discuss how life history drawings can serve as a valuable method for global health research. The introduction discusses qualitative approaches to concepts such as reliability, validity and triangulation, and situates the use of participatory visual methods within the broader field of participatory research. The paper reports on an experience using life history drawings as part of extended ethnographic research in rural Mexico and among Mexican migrants living in Atlanta. The primary method for that parent project was comparative ethnographic research, which included life histories collected from 13 pairs of women over 15 months of participant observation. Early in the research, the drawings contributed to a major reorientation in the direction of the research project. The insights generated through analysis of the life history drawings exemplify how this participatory research technique can direct attention to social processes that feel salient to community members. In this case, they called attention to the enormity of social change in this community over one generation, reorienting the study from one focused on change causes by migration to one that focused on two trajectories of change: generational and migration-related. [ABSTRACT FROM AUTHOR]

Global health research typically relies on the translation of knowledge (from health professionals to the community) and the dissemination of knowledge (from research results to the wider public). However, Greenhalgh and Wieringa [2011. Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review.Journal of the Royal Society of Medicine, 104(12), 501–509. doi:10.1258/jrsm.2011.110285] suggest ‘that while “translation” is a widely used metaphor in medicine, it constrains how we conceptualize and study the link between knowledge and practice’ (p. 501). Often the knowledge garnered from such research projects comes from health professionals rather than reflecting the lived experiences of people and communities. Likewise, there has been a gap in ‘translating’ and ‘disseminating’ the results of participatory action research projects to policymakers and medical practitioners. This paper will look at how using participatory visual methodologies in global health research with children and youth facing global adversity incorporates the multiple functions of their lived realities so that research becomes a means of intervention. Drawing from a literature review of participatory visual methods as media, content and processes of global health research, this paper raises practical, theoretical, and ethical questions that arise from research as intervention. The paper concludes by exploring what lessons emerge when participatory visual methodologies are integrated into global health research with children and youth facing global adversity. [ABSTRACT FROM AUTHOR]

We report on a comparative situational analysis of comprehensive abortion care (CAC) in Botswana, Eswatini, Lesotho and Namibia. We conducted systematic literature searches and country consultations and used a reparative health justice approach (with four dimensions) for the analysis. The following findings pertain to all four countries, except where indicated. Individual material dimension: pervasive gender-based violence (GBV); unmet need for contraception (15−17%); high HIV prevalence; poor abortion access for rape survivors; fees for sexual and reproductive health (SRH) services (Eswatini). Collective material dimension: no clear national budgeting for SRH; over-reliance on donor funding (Eswatini; Lesotho); no national CAC guidelines or guidance on legal abortion access; poor data collection and management systems; shortage and inequitable distribution of staff; few facilities providing abortion care. Individual symbolic dimension: gender norms justify GBV; stigma attached to both abortion and unwed or early pregnancies. Collective symbolic dimension: policy commitments to reducing unsafe abortion and to post-abortion care, but not to increasing access to legal abortion; inadequate research; contradictions in abortion legislation (Botswana); inadequate staff training in CAC. Political will to ensure CAC within the country's legislation is required. Reparative health justice comparisons provide a powerful tool for foregrounding necessary policy and practice change. [ABSTRACT FROM AUTHOR]

Prior studies on substance use in Brazil have not focused on opioid misuse, previously thought to be nearly non-existent. This paper presents new findings on heroin and non-medical use of opioid analgesics. Data come from the 2015 Brazilian Household Survey on Substance Use (BHSU-3), a nationally representative survey estimating epidemiological parameters related to substance use by residents across Brazil. BHSU-3 used stratified multi-stage probability sampling across multiple geographic domains of interest, resulting in 16,273 interviews with household residents. Lifetime heroin use among Brazilians was 0.3 (95% C.I:0.2–0.4). Lifetime, past-year, and past-month non-medical use of opioid analgesics were respectively 2.9 (95%C.I.:2.3–3.4), 1.4 (95%C.I.:1.1–1.7) and 0.6 (95%C.I.:0.4–0.8). Past-year prevalence of non-medical opioid analgesics use was lower among males [Prevalence Ratio (PR): 0.54 (95% C.I.:0.36–0.78)], those aged 12–24 [0.56 (95% C.I.:0.34–0.92)], persons with monthly family incomes between R$1,501–3,000 [0.59 (95% C.I.:0.38–0.92)] or greater than R$3,000 [0.64 (95% C.I.:0.42–0.98)], and persons who were unemployed [0.65 (95% C.I.:0.46–0.92)]. Non-medical use of opioids in Brazil may be more prevalent than previously recognised. Proper measurement and evaluation of opioid misuse across Brazil and other Latin American countries is critical to understand and prevent opioid-related harms. [ABSTRACT FROM AUTHOR]

Public health and media discourses on men and HIV prevention in India have largely focused on changing knowledge, attitudes and risk behaviour pertaining to condom use and safe sex. Little attempt has been made towards intervening in areas such as masculinity, dominant gender norms and intimate partner violence (IPV) that have been shown to have a direct link to HIV prevalence. In this paper, drawing on findings from an ethnographic study in northern Karnataka (India), we show how socio-political and communicative contexts influence and perpetuate violent behaviours by men in intimate relationships with female sex workers (FSW). We argue that constructions of masculinity, the stereotypes of which are reinforced through contemporary media, and movies, are intricately linked with processes of nationalism and play out in forms of chauvinism among working-class men. Violence, celebrated through various patriarchal discourses, legitimises and reinforces gender ideals that govern the private lives of men and their female intimate partners. This study provides a complex and nuanced understanding of structural factors that lead to IPV against FSWs and offers implications for HIV intervention planning in the region and beyond. [ABSTRACT FROM AUTHOR]

South Africa has increasing numbers of persons living with HIV on antiretroviral treatment (ART). There is evidence for a relationship between food, food security and HIV. Despite increasing rates of people older than 50 living with HIV coinciding with greater levels of co-morbidity, the existing research is largely limited to those aged 15–49 years. In this paper, we therefore explore how older people living with HIV (OPLWH) in two urban communities within South Africa negotiate and ensure they have sufficient access to food and how food insecurity may affect their retention in care and ART adherence. This study used exploratory qualitative semi-structured in-depth interviews with 23 OPLWH to collect data in isiXhosa. Data were analysed using thematic content analysis. Factors at the community, household and individual levels influence (a) access to sufficient and quality food, and (b) beliefs about ART and food based on (mis)understandings of messaging from health care providers. The results demonstrate the need to explore further and clarify the nutritional guidelines that OPLWH receive from providers to ensure this does not result in reduced adherence or retention in care. They also demonstrate the role that social welfare and family or kin obligations plays in ensuring the food security of OPLWH. [ABSTRACT FROM AUTHOR]

Using the example of a human rights training in Nepal, the author looks at global body politics in a reflexive piece on her engagement in development practices that translate western feminist ideas on gender inequality and empowerment via UN human rights policies into non-western contexts. It firsts look at postcolonial and critical literature on feminist engagement in gender and development processes including a discussion on the concept of global body politics before examining briefly the framing of gender-based violence in Nepal. The core of the paper is a reflexive analysis and interrogation of the training in Nepal in order to bring out the tensions and contradictions around western developmental, feminist and human rights discourses. The discussion looks at how difficult it is for feminist, human rights and developmental discourses and practices to unmoor themselves from the notion of the ‘expert’ and those who do the rights/work/righting rights training and those who are perennially seen as requiring training. The conclusion reflects on possibilities of other epistemic practices found in intercultural dialogues. [ABSTRACT FROM AUTHOR]

The last 20 years have seen a proliferation of research, spurred by the imperatives of the HIV epidemic and reportedly high rates of gender-based violence, on heterosexual practices in the South African context. Research has focused on how poverty, age and gender within specific cultural contexts shape sexual agency and provide a context for unequal, coercive and violent practices for young women. This paper takes stock of what we currently ‘know’ about heterosex and critically reflects on the political and ideological effects of such research, specifically in the light of young women's agency. A primary concern is that efforts to address gender inequality and the normative gender practices that shape inequitable heterosexual practices may have functioned to reproduce the very discourses that underpin such inequalities. The paper ‘troubles’ the victim–agency binarism as it has been played out in South African research on heterosex, raising concerns about how the research may reproduce gendered, classed and raced othering practices and discourses and bolstered regulatory and disciplinary responses to young women's sexualities. The paper argues for critical, feminist self-reflexivity that should extend to re-thinking methodologies entrenched in frameworks of authority and surveillance. [ABSTRACT FROM AUTHOR]

Despite being highly vulnerable to acquiring HIV, no effective evidence-based interventions (EBI) exist for street-connected young people (SCY) in low- and middle-income countries (LMICs). Therefore, this paper describes the research process of adapting an existing EBI in Eldoret, Kenya using a modified ADAPT-ITT model with a young key population. From May to August 2018 we adapted the combined Stepping Stones and Creating Futures interventions. We used community-based participatory methods, focus group discussions, and working groups with four Peer Facilitators and 24 SCY aged 16–24 years. At the inception of this project, a matched-savings programme was integrated into the intervention to further address structural drivers of HIV. Numerous adaptations came forth through the participatory process. Engaging SCY in the adaptation process ensured the programme was responsive to their needs, relevant to the street context, and respected their right to participate in the research process. [ABSTRACT FROM AUTHOR]

The Caribbean, accessed significant external funding over the first three decades of the epidemic, which provided local authorities the opportunity to defer their responsibility in leading or matching the support provided from the external agencies. The reduction in external support has placed increased pressure on the response to the epidemic, with some countries more likely to be affected than others. This paper undertakes a review of the expenditure and funding landscape for HIV programs in the Caribbean. The findings confirm that despite the dwindling number of funding sources, some countries continue to display a significant degree of dependency on external funding sources. It is noteworthy that Treatment and Care accounted for the largest share of HIV expenditure in those countries, which displayed the highest degree of dependency on external funding. While, HIV spending was a relatively small percentage of both total health expenditure and gross domestic product, expenditure levels were noticeably higher in Haiti. These averages however conceal significant differences across countries, which should inform the magnitude and direction of any spending expansion by these countries if they are to achieve financial sustainability. Some recommendations are provided on the way forward to facilitate building a sustainable response to the epidemic. [ABSTRACT FROM AUTHOR]

The conceptual and practical work done by social medicine and global health have often overlapped. In this paper, we argue that new efforts to apprehend 'the social' in social medicine offer important insights to global health along five lines of critical analysis: (1) reconfigurations of the state and new forms of political activism, (2) philanthrocapitalism and the economisation of life, (3) The economy of attention, (4) anthropogenic climate change, and (5) the geopolitics of North and South. [ABSTRACT FROM AUTHOR]

The HIV response is hampered by many obstacles to progression along the HIV care cascade, with men, in particular, experiencing different forms of disruption. One group of men, whose stories remain untold, are those who have succumbed to HIV-related illness. In this paper, we explore how next-of-kin account for the death of a male relative. We conducted 26 qualitative after-death interviews with family members of male PLHIV who had recently died from HIV in health and demographic surveillance sites in Malawi, Tanzania, Kenya, Uganda, Zimbabwe and South Africa. The next-of-kin expressed frustration about the defiance of their male relative to disclose his HIV status and ask for support, and attributed this to shame, fear and a lack of self-acceptance of HIV diagnosis. Next-of-kin painted a picture of their male relative as rebellious. Some claimed that their deceased relative deliberately ignored instructions received by the health worker. Others described their male relatives as unable to maintain caring relationships that would avail day-to-day treatment partners, and give purpose to their lives. Through these accounts, next-of-kin vocalised the perceived rebellious behaviour of these men, and in the process of doing so neutralised their responsibility for the premature death of their relative. [ABSTRACT FROM AUTHOR]

Evidence from the past 40 years of HIV technology development and implementation indicates that the public health social contract – with its expectations of patient/citizen compliance – has hampered global disease control efforts. Despite the availability of a wide array of effective technologies, including antiretroviral drugs as treatment and prevention, voluntary medical male circumcision procedures, and newly developed intravaginal ring products, new infections among adults globally have not decreased significantly. In this paper, I describe a historical trend of limiting access to effective biomedical technologies to those deemed most deserving and compliant given concerns of misuse (non-adherence), product repurposing (not using the product for purposes originally intended), and the incitement of autonomy (increasing the risk of public exposure to diseases given personal protection from a specific disease). Examining the expectations of good citizenship (compliance, adherence, appropriate product use, and continued risk reduction) as it relates to human-technology interactions, reveals a continuing narrative of initially restricting access to newer technologies perceived fragile or costly based on an assessment of patient/citizen worth. In this, the conventional public health social contract continues to be an obstacle in the advancements of technologies to effectively reduce the global burden of HIV. [ABSTRACT FROM AUTHOR]

Syndemics theory has been applied to the structurally shaped, biologically facilitated co-occurrence of HIV/AIDS with Neglected Tropical Diseases (NTDs) and with sexually transmitted infections (STIs). The biological and social pathways of interaction between all three ailments have not yet been analysed together. The effects of these diseases are often exacerbated by structural factors including access to care and socioeconomic status. We explore the interrelated biological pathways and structural factors that have further heightened the risk for HIV/AIDS, NTDs, and STIs. Furthermore, we argue women in rural areas are at an increased risk for all three diseases due to biological and social factors including increased distance to quality care and lower reproductive autonomy. This paper integrates the established syndemics of HIV/NTDs and HIV/STIs within the historical and modern contexts of colonisation and neo-colonisation in Nigeria. We explore the effects of colonisation on women's health by evaluating the influence of foreign aid policies, structural programmes, and shifting gender norms. Applying a syndemic approach, juxtaposed by historical contextualisation, offers important implications for the prevention and treatment of HIV/AIDS, STIs, and NTDs. Our analysis suggests a perspective through which to view health of regions with a history of colonisation. [ABSTRACT FROM AUTHOR]

Non-consensual sterilisation is not only a historic abuse. Cases of unethical treatment of women around the time of a pregnancy continue in the Twenty-First Century in five continents. Sterilisation is being carried out by some healthcare professionals at the time of delivery, or soon afterwards, without valid consent. A range of contemporary examples of such practices is given. Respecting women's autonomy should be the touchstone of the consent process. Avoidance of force, duress, deception and manipulation should go without saying. Ethnic minority communities and women living with HIV, in particular, are being targeted for this kind of abuse. Attempts have been made in various countries and by international professional organisations to introduce clinical guidelines to steer health professionals away from this malpractice. Survivors have sought justice in domestic and international courts. This paper critically assesses the evidence on the practical, ethical and legal issues around the handling of consent for these procedures. Suggestions are made about possible regulatory responses that address abuse, whilst maintaining access for those individuals who freely elect to undergo these procedures. [ABSTRACT FROM AUTHOR]

While Female Genital Mutilation (FGM) has been in existence for centuries, the rigorous and systematic documentation of the extent of the practice is a recent undertaking. This paper discusses data availability related to the practice of FGM and reviews the methods used to generate prevalence estimates. The aim is to illustrate strengths and limitations of the available data. The review is organised around two main categories of countries: FGM countries of origin, where representative prevalence data exist, and countries of migration for women and girls who have undergone FGM, for which representative prevalence data are lacking. This second category also includes countries across the world where FGM is only found among small autochthonous populations. [ABSTRACT FROM AUTHOR]

Uganda suffered four Ebola and five Marburg virus outbreaks from 2000 to 2012 with significant health worker mortality. This paper describes findings from 41 interviews with health workers from three outbreaks. Interviewees frequently encountered stigma from their communities, sometimes accompanied by mistrust and violence. These difficulties were defined as 'challenges of society.' Health workers also suffered emotional trauma, depressive symptoms, and fear classified as 'challenges of psyche.' As the incidence of such outbreaks will likely increase due to ecological and economic trends, health workers require greater access to personal protective equipment (PPE) and knowledge of viral containment. Such improvements would create an optimal psychosocial climate for managing infectious patients ultimately decreasing the severity of future outbreaks. [ABSTRACT FROM AUTHOR]

Because HIV and AIDS key populations share common social-cultural factors challenging their sexual health and rights (e.g. stigma, criminalisation), there is an assumed benefit of collaborative programmes where various key populations work in solidarity. In this paper, we reflect on how partners collaborated in a complex alliance of over 100 different NGOs, representing and supporting three key populations – lesbian, gay, bisexual and transgender (LGBT) people, sex workers and people who use drugs – working across 16 countries. We used a multiple-method approach of participant observation, qualitative interviews, and a survey to explore the benefits, facilitators and challenges of collaboration. Results show that motivators for collaboration included being part of the larger funding structure with applied impacts, a repressive human rights context, and intersectionality. Barriers for collaboration included identity politics, stigma, and constraints regarding the appropriate timing of new collaborations. Finally, facilitators include practical support for engagement, the framing of human rights in a medical agenda, and recognition of implicit differences. We conclude that for building the capacity for collaboration among socially marginalised groups it is important to develop trust and the ability to recognise strength in difference beyond the initial identification of shared norms and common goals. [ABSTRACT FROM AUTHOR]

In recent years, research on the military deployment of unmanned aerial vehicles (UAVs), or drones, has proliferated. However, to date there has been little systematic study of how drones are being used for health surveillance and management, particularly in resource-constrained settings. In this paper, we draw on a number of case studies to explore how the biomedical drone is contributing to a re-spatialization of health and to a process of datafication that is set to fundamentally change the nature and scope of health governance. The promotion of the drone as a solution to global challenges reflects a broader techno-optimism. However, drones and the cybernetworks they rely on are short-circuiting terrestrial systems and driving a strategic, hotspot approach to health. This targeted view of the world, we argue, recapitulates and extends earlier forms of colonial surveillance and intervention premised on security and incipient threat. We develop the notion of 'anarchitecture' to describe the formation of these new inverted health landscapes where state infrastructures are entangled with shifting technological networks. In short, we seek to develop a framework for reflecting on the ways in which global health is being reconfigured through the development of remote-sensing technologies and cyberinfrastructures. [ABSTRACT FROM AUTHOR]

As part of a planned series from Global Public Health aimed at exploring both the epistemological and political differences in diverse public health approaches across different geographic and cultural regions, this special issue assembles papers that consider the legacy of the Latin American Social Medicine and Collective Health (LASM-CH) movements, as well as additional examples of contemporary social action for collective health from the region. In this introduction, we review the historical roots of LASM-CH and the movement's primary contributions to research, activism and policy-making over the latter-half of the twentieth century. We also introduce the special issue's contents. Spanning 19 papers, the articles in this special issue offer critical insight into efforts to create more equitable, participatory health regimes in the context of significant social and political change that many of the countries in the region have experienced in recent decades. We argue that as global health worldwide has been pushed to adopt increasingly conservative agendas, recognition of and attention to the legacies of Latin America's epistemological innovations and social movement action in the domain of public health are especially warranted. [ABSTRACT FROM AUTHOR]

Community participation as a strategy in health aims to increase the role of citizens in health decision-making which are contextualised within the institutions of democracy. Electoral representation as the dominant model of democracy globally is based on the elite theory of democracy that sees political decision-making a prerogative of political elites. Such political elitism is counter to the idea of democratic participation. Neoliberalism together with elitism in political sphere have worsened social inequities by undermining working class interests. Latin America has seen adverse consequences of these social inequities. In response, social movements representing collective struggles of organised citizens arose in the region. This paper explores the theoretical underpinnings of democratic participation in contemporary Latin American context at the nexus of emerging social movement activism and policy responses. The paper will use empirical examples to highlight how such democratic practices at the societal level evolved while demanding political inclusion. These societal democratic practices in Latin America are redefining democracy, which continues to be seen in the political sphere only. Health reforms promoting participatory democracy in several Latin American countries have demonstrated that establishing institutions and mechanisms of democratic participation facilitate collective participation by the organised citizenry in state affairs. [ABSTRACT FROM AUTHOR]

This paper examines the international networks that influenced ideas and policy in social medicine in the 1930s and 1940s in Latin America, focusing on institutional networks organised by the League of Nations Health Organization, the International Labour Organization, and the Pan-American Sanitary Bureau. After examining the architecture of these networks, this paper traces their influence on social and health policy in two policy domains: social security and nutrition. Closer scrutiny of a series of international conferences and local media accounts of them reveals that international networks were not just 'conveyor belts' for policy ideas from the industrialised countries of the US and Europe into Latin America; rather, there was often contentious debate over the relevance and appropriateness of health and social policy models in the Latin American context. Recognition of difference between Latin America and the global economic core regions was a key impetus for seeking 'national solutions to national problems' in countries like Argentina and Chile, even as integration into these networks provided progressive doctors, scientists, and other intellectuals important international support for local political reforms. [ABSTRACT FROM AUTHOR]

Under President Rafael Correa (2007–2017), Ecuador's Ministry of Health established a state-centred health care regime that incorporates elements of Latin American social medicine into post-neoliberalism. These initiatives – which are part of 'The National Plan for Good Living (Buen Vivir)' – include free healthcare, greater attention to social determinants of health, a focus on equity and inclusion, and increased coordination across welfare, health, and development sectors. However, the reforms also use health services to build a sense of inclusive, participatory citizenship, with the Ecuadorean state as the central figure in service provision. In this paper, we demonstrate that state-centred health care reforms have paradoxically weakened community organising for collective health. Drawing on seventeen years of ethnographic research and health solidarity work in rural Northwest Ecuador, we illustrate how Ecuador's health reforms have reconfigured relations among local civil society, transnational NGOs, and the state. Established modes of community participation and international collaboration have been undermined largely because these reforms ignore community sovereignty and self-organisation and overemphasise the threat of neoliberalism. The lessons about balancing the state-based fulfilment of rights with community power are relevant to social medicine advocates, particularly those working in rural communities that are already organising creatively for their own health and well-being. [ABSTRACT FROM AUTHOR]

Diabetes has become a leading cause of death in Belize, making this Central American country emblematic of challenges amplified by a growing global diabetes epidemic. The struggles people face as they seek care for chronic conditions like diabetes (and its complications such as kidney failure) are bringing citizens and institutions alike to revisit longstanding norms about the terms through which healthcare is accessed. Ethnographically tracing Belize's first patient-driven healthcare protests and activism – an ad hoc movement for public dialysis that began over a decade ago – this paper examines patients' and caregivers' struggles to probe and shape a legacy of social justice health activism, drawing on perspectives from an often-overlooked part of Central America where basic healthcare access has not historically been framed as a right of citizens. It considers these dilemmas in relation to much larger chronic struggles 'to maintain' and repair bodies, medical technologies, and health systems in the aftermath of colonial legacies – with special attention to the challenges posed for small countries now facing rising issues of diabetes injuries and chronic complications – and the role of civic media and citizen activism in this context. [ABSTRACT FROM AUTHOR]

The neoliberal reforms of the early 1990s in Colombia, mainly labour and social security reforms, transformed capital-labour relations and contributed to the erosion of working conditions and health protection at work, with devastating impacts on workers' health. In the context of these dramatic changes, Colombian workers mobilised around collective identities that have shaped new forms of workers' struggle and resistance. Since 2006, associations of workers suffering work-related illnesses have been active in Colombia. The associated workers engaged in collective actions have demanded from employers, the Ministry of Work, occupational risk administrators, disability rating boards and the judicial system the recognition of certain diseases as being of occupational origin and that these entities guarantee corresponding labour, economic and social security rights. This paper describes and analyses the dynamics of the struggle for the right to health at work undertaken by these associations in Colombia, adopting an analytical perspective inspired by collective action theory. [ABSTRACT FROM AUTHOR]

The mental health users' movement is a worldwide phenomenon that seeks to resist disempowerment and marginalisation of people living with mental illness. The Latin American Collective Health movement sees the mental health users' movement as an opportunity for power redistribution and for autonomous participation. The present paper aims to analyze the users' movement in Argentina from a Collective Health perspective, by tracing the history of users' movement in the Country. A heterogeneous research team used a qualitative approach to study mental health users' associations in Argentina. The local impact of the Convention on the Rights of Persons with Disabilities and the regulations of Argentina's National Mental Health Law are taken as fundamental milestones. A strong tradition of social activism in Argentina ensured that the mental health care reforms included users' involvement. However, the resulting growth of users' associations after 2006, mainly to promote their participation through institutional channels, has not been followed by a more radical power distribution. Associations dedicated to the self-advocacy include a combination of actors with different motives. Despite the need for users to form alliances with other actors to gain ground, professional power struggles and the historical disempowerment of 'patients' stand as obstacles for users' autonomous participation. [ABSTRACT FROM AUTHOR]