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Assessing global progress on human adaptation to climate change is an urgent priority. Although the literature on adaptation to climate change is rapidly expanding, little is known about the actual extent of implementation. We systematically screened >48,000 articles using machine learning methods and a global network of 126 researchers. Our synthesis of the resulting 1,682 articles presents a systematic and comprehensive global stocktake of implemented human adaptation to climate change. Documented adaptations were largely fragmented, local and incremental, with limited evidence of transformational adaptation and negligible evidence of risk reduction outcomes. We identify eight priorities for global adaptation research: assess the effectiveness of adaptation responses, enhance the understanding of limits to adaptation, enable individuals and civil society to adapt, include missing places, scholars and scholarship, understand private sector responses, improve methods for synthesizing different forms of evidence, assess the adaptation at different temperature thresholds, and improve the inclusion of timescale and the dynamics of responses.

This mixed-methods, exploratory study examined why women living with HIV (WLHIV) stay in intimate partner violence (IPV) relationships and what helps end IPV in their lives. WLHIV (n = 108) who experienced IPV and were patients at two HIV primary care clinics in San Francisco completed quantitative surveys; 15 participants also completed a qualitative interview. Qualitative data showed HIV stigma was the most cited reason for staying in an IPV relationship, followed by substance use, and then by themes of attachment insecurity. Quantitative data indicated that most participants accessed HIV services and rated them as more helpful than other community resources to end IPV in their lives. Enduring attachment relationships with HIV medical and social service providers and their attachment-enhancing actions and attributes were critical to participants addressing IPV and coping with HIV stigma. This study highlights the important role that HIV providers and clinics can play in addressing IPV among WLHIV.

BackgroundTrauma is increasingly recognized as a near-universal experience among women living with HIV (WLHIV) and a key contributor to HIV acquisition, morbidity, and mortality.MethodsWe present data from the baseline analysis of a planned intervention trial of the impact of trauma-informed health care on physical, behavioral, and social health outcomes of WLHIV in one clinic, with a particular focus on quality of life and viral suppression. Data were collected through interviewer-administered surveys and electronic health record data abstraction.ResultsAmong 104 WLHIV, 97.1% of participants reported having experienced lifetime trauma, and participants had experienced on average 4.2 out of 10 Adverse Childhood Experiences. WLHIV with more lifetime trauma were significantly more likely to report post-traumatic stress disorder, depression, and anxiety symptoms; significantly more likely to report potentially harmful alcohol and drug use; and had a significantly poorer quality of life. In addition, women who had experienced more lifetime trauma were significantly less likely to report being on and adhering to HIV medications, although trauma was not significantly associated with having an undetectable HIV viral load.ConclusionsThese data suggest that trauma is associated with much of the morbidity and mortality experienced by WLHIV. The results of this study support the implementation and study of trauma-informed approaches to health care for WLHIV.

BACKGROUND:Trauma-informed health care for women living with human immunodeficiency virus (HIV) attends not only to HIV treatment, but also to the many common physical and emotional health consequences of trauma. One principle of providing trauma-informed care is the acknowledgement that working with a population that has experienced extensive trauma affects the team members who care for them in the clinic, as well as the interactions between those team members. METHODS:To understand the needs of one primary health care team, we conducted in-depth interviews with 21 providers, staff, and collaborators who provide care to patients within the clinic. We used symbolic interaction and grounded theory methods to examine how interactions unfold within the clinic and how they are influenced by trauma. RESULTS:The clinic team serves a highly traumatized and vulnerable population. Within this context, interactions between clinic staff unfold and trauma surfaces, and power dynamics play out along the lines of professional hierarchy. Although power differences cause tension within the clinic, professional hierarchy also serves as an important division of labor in times of medical crises. CONCLUSIONS:Clinic power dynamics may be influenced to improve the care environment for patients, and to realize a more effective and satisfying trauma-informed health care clinic for both patients and staff.

Transgender women living with HIV experience high rates of substance use, violence, and post-traumatic stress disorder (PTSD). Seeking Safety is a manualized, present-focused, cognitive-behavioral therapy program designed to address co-occurring substance use and PTSD. Seeking Safety has evidence of efficacy in a variety of populations but had not been evaluated specifically with people living with HIV or transgender women. We pilot-tested a 12-session Seeking Safety program with a group of transgender women living with HIV who reported substance use and a history of violence. Seven transgender women living with HIV were recruited from two HIV primary care clinics in San Francisco and completed pre- and post-intervention assessments. Participants attended an average of 8 of the 12 sessions. Mean scores for all three outcome measures improved: PTSD symptom scores declined 17.5%, alcoholism screening scores declined 23.9%, and drug abuse screening scores declined 68.8%, on average. Despite the small sample, this pilot study showed Seeking Safety to be a promising intervention among transgender women living with HIV. The findings are encouraging and justify larger studies of Seeking Safety among transgender women and other people living with HIV who experience high rates of substance use and PTSD.

Amid the surge in research on mobility and migration in the context of environmental change, little research has focused on the experiences of people for whom travel is cyclical and a part of daily, weekly, or seasonal life. For Inuit in Arctic North America, the land is the heart of cultural and community life. Disruption to time spent on the land is reported to impact the emotional health and well-being of individuals and communities. There is concern that environmental change is creating barriers to safe travel, constituting a creeping disaster. We systematically review and evaluate the literature for discussion of barriers to travel for Inuit in Arctic North America, using an approach from the field of disaster anthropology to identify root causes of constraints to mobility. We identify root causes of risk and barriers to time spent on the land. These emerge from historic and contemporary colonial policy and inequality, as opposed to environmental hazards per se, impacting people's mobility in profound ways and enacting a form of slow violence. These results suggest a need to understand the underlying processes and institutions that put people at risk. [ABSTRACT FROM AUTHOR]

This article contributes to the field of mixed methods by introducing a new method for eliciting participant perspectives of the quantitative results of randomized controlled trials. Participants are rarely asked to interpret trial results, obscuring potentially valuable information about why a trial either succeeds or fails. We introduce a unique method called visual participatory analysis and discuss the insights gained in its use as part of a trial to prevent risk and reduce the prevalence of diabetes in Bangladesh. Findings highlight benefits such as elucidating contextualized explanations for null results and identifying causal mechanisms, as well as challenges around communicating randomized controlled trial methodologies to lay audiences. We conclude that visual participatory analysis is a valuable method to use after a trial. [ABSTRACT FROM AUTHOR]