Search

In recognition of the broader relational aspects of viral infections, family support is considered important when someone is diagnosed with a blood-borne virus (BBV), such as HIV, hepatitis C (HCV) and hepatitis B (HBV). However, families' own support needs are often not a priority in service provision within the BBV sector. In this article, we draw on qualitative interviews with 20 key informants working in various professional capacities in health, social policy, care and advocacy sectors in Australia, and explore their experiences and perspectives on family inclusivity in their services. Overall, key informants acknowledged the diversity of what constitutes family, and consistently viewed family engagement as beneficial to both diagnosed individuals and the wider familial networks affected by a diagnosis. However, prioritising individual care in support services presented barriers to engaging families, which are further complicated by the role of stigma in shaping the social realities of living with a BBV. Increasing understanding in service provision settings that serodiscordance can be a family experience has the potential to widen this analytic lens to consider the support needs of families in their own right. [ABSTRACT FROM AUTHOR]

In contrast to most industrialized countries, maternal mortality in the USA is rising. Cardiovascular disease, both acquired heart disease (e.g. coronary disease, arrhythmias, and heart failure), as well as congenital heart disease survivors, are all potentially important factors in explaining this worrisome trend. Increase in acquired cardiac disease is likely attributable to greater rates of obesity, diabetes, hypertension, and an increase in the incidence of advanced maternal age, while congenital heart disease in pregnancy is increasing due to advances in pediatric cardiovascular surgery. Despite the growing cardiovascular risk of pregnant women, most obstetricians and cardiologists have limited experience in caring for women with heart disease. Accordingly, management is largely guided by expert opinion likely to vary greatly across centers. To address these challenges, a multidisciplinary approach to care that includes both cardiologists and obstetricians could leverage the knowledge of both specialties and support streamlined communication between the patient and her providers. Our experience highlights the necessary components and essential infrastructure for building a center of excellence in treating pregnant women with heart disease.Condensation: A guide for creating a center of excellence for prenatal care for women with cardiovascular disease.The problem: Cardiac disease is the leading cause of maternal mortality, and pregnancies affected by cardiac disease continue to rise, both congenital and acquired.The solution: Maternal fetal medicine, obstetricians, and cardiologists can join together in tertiary facilities to create Maternal Cardiac Centers of Excellence to provide multidisciplinary, structured care for these high-risk patients. [ABSTRACT FROM AUTHOR]

Young people in residential alcohol and other drug (AOD) services build meaningful relationships with workers during their stays. In this paper we use an ethics of care framework to explore what young people said about care, how it was delivered and what they valued about it. Drawing on three waves of longitudinal interviews conducted with 38 young people over 12 months, we discuss our findings according to two overarching themes – opportunities enabled by care and limits to care. Young people’s descriptions highlight the potential for care to challenge stigma, enhance self-worth and wellbeing, enable respectful staff-client relationships, and foster positive relationships crucial for maintaining engagement. At the same time, young people described challenges around providing both individual and collective care, coproducing care in structured environments, and facilitating care as young people transition out of residential services. These findings shed light on the delicate balance between care provision and contextual constraints within AOD settings. This emphasises the need for ethical relationships built on clear communication, mutual respect, and ongoing forms of care. Recognising the value of care work, especially in transitions out of acute treatment services, is essential for reshaping funding approaches to prioritise meaningful and continuing care. [ABSTRACT FROM AUTHOR]

This article describes findings from an Australian mixed method study, and explores young people's perceptions of police. We focus on the nature of positive experiences, and the potential for positive encounters to improve outcomes for young offenders affected by problematic alcohol and other drug use. Buber's concept of dialogical interaction is used to articulate the components of a positive experience and how this increases police legitimacy. In doing so, we demonstrate that, despite negative experiences, young people can be sympathetic to the tensions of modern policing, and can envisage police as positive role models. As such, police can enhance outcomes for 'vulnerable' young people through more respectful interactions. [ABSTRACT FROM AUTHOR]

Domestic and family violence (DFV) and child maltreatment have been widely identified as co-occurring social phenomena. It has been well established that children living in an environment of DFV are at significant risk of either directly experiencing violence themselves, or being neglected due to their parents' reduced caregiving capacity. In order to effectively address clients' presenting concerns, intervention responses must account for the overlap between these social issues. This article describes the experience of DFV and child protection involvement as experienced by clients attending two different interventions at Relationships Australia NSW; group programs for DFV perpetration or victimisation; and a parenting program in the context of statutory child removal. Findings provide evidence of overlap between these issues and highlight how a supportive and non-judgemental group environment can allow parents to make behavioural changes and equip themselves to provide a safe and nurturing environment in which to raise their children. [ABSTRACT FROM AUTHOR]

Hepatitis C (HCV) is a stigmatised disease due, in part, to an association with injecting drug use. Aboriginal Australians, a stigmatised group, are over-represented in patterns of HCV infections. We examined the experience of Aboriginal Australians living with HCV using qualitative in-depth interviews, paying particular attention to instances where multiple stigma mechanisms (relating to HCV, injecting drug use and Aboriginal identity) overlapped. Stigma held a central role in the experience of most of the 39 participants with reports of exclusion and alienation from families and communities. HCV-related stigma was accompanied by the notion of 'shame' which holds deep cultural significance for Aboriginal people. Participants' accounts revealed overlapping stigma in their perception that others 'automatically' expect Aboriginal people to have a stigmatised disease such as HCV. HCV as a contemporary expression of colonisation was also woven into accounts of HCV-related stigma. Interventions to reduce HCV stigma should be specifically designed for minority populations to account for multiple, overlapping sources of stigma. [ABSTRACT FROM AUTHOR]

Introduction. Despite Aboriginal Australians being over-represented in populations of people living with hepatitis C (HCV), there is a dearth of research to guide policy and programme development in the area of care and treatment, particularly relating to new HCV treatments. Method. In-depth interviews were conducted with 39 people identifying as Aboriginal Australians and living with HCV in New South Wales. Results. Participants' experiences were characterised by a lack of detailed or appropriate information provided at diagnosis, high levels of stigma associated with HCV and low overall knowledge of HCV as reported for themselves and their communities. Despite poor diagnosis experiences, participants had undertaken changes to their lifestyle, especially in relation to alcohol use, in order to promote liver health. Concerns about treatment side effects and efficacy impacted participants' decisions to undertake treatment. Eleven participants had undertaken HCV treatment in a variety of care models with a peer worker and in prison. Conclusions. The similarities between concerns and experiences of Aboriginal people and other populations living with HCV do not suggest that services and strategies to engage these populations should also be the same. These results suggest that further engagement of the primary care sector in HCV care is important as well as increasing Aboriginal community knowledge of HCV. A variety of service models should be available to meet individuals' preferences, including those offered within Aboriginal community controlled health services emphasising holistic notions of health, and supported by information and communication programmes using principles of health literacy relevant to Aboriginal people. [ABSTRACT FROM AUTHOR]

Relationships Australia NSW and Baptist Community Services NSW & ACT, through its BCS LifeCare Counselling & Family Services program, collaborated to explore client perceptions of men's domestic violence programs. Recruitment targeted male clients and their female partners, across six locations in New South Wales, Australia. In total, 63 qualitative interviews were gathered from 28 participants, between 2007 and 2009, at program intake, program completion and 6-month follow-up. The focus of this article is on the 20 male interviews conducted with 14 participants at program completion (10) and at 6-month follow-up (10). Recurring themes from these interviews indicate the potentially disruptive effect of client dialogue on group dynamics. While positive group discussion has the potential to enhance client motivation, negative peer discussions, external to group sessions, can diminish group functioning and client motivation for these participants. The paradoxical nature of the group-intervention experience is explored in light of these accounts. Suggestions for men's domestic violence program facilitation and research are outlined. [ABSTRACT FROM PUBLISHER]

Although problem gamblers make up a small proportion of the New Zealand population, those who are living in more deprived areas at higher risk of harm from their own or someone else's gambling. The global financial crisis in 2008 has been linked with changes in gambling behaviour and with increases in inequality between areas of relative deprivation. Nationally representative datasets from in-home face-to-face health surveys in 2008, 2010 and 2012 were analysed to investigate changes in gambling behaviour, experiences of household-level harm related to gambling, and the association with economic deprivation. Although overall gambling participation had dropped, the experience of gambling harm at the household level was significantly higher in 2012 compared with 2008 and 2010. The increase in harm was experienced disproportionately by those in more deprived areas, who were 4.5 times as likely to experience gambling-related arguments or money problems. We consider possible explanations including more harmful gambling behaviour as a response to financial stresses, decreasing household resilience to financial stresses, and the concentration of more harmful forms of gambling product in more deprived areas. Causes of gambling harm in deprived communities, and the vulnerability of households in these communities, should be addressed if inequalities are to be reduced. [ABSTRACT FROM AUTHOR]

Objectives.Cancer is the second biggest killer of Aboriginal Australians. For some cancers, the mortality rate is more than three times higher in Aboriginal people than for non-Aboriginal people. The Aboriginal Patterns of Cancer Care Study explored barriers to and facilitators of cancer diagnosis and treatment among Aboriginal and Torres Strait Islander people in New South Wales. Design.Our team – which includes both Aboriginal and non-Aboriginal researchers – conducted in-depth interviews between 2009 and 2010 with Aboriginal people with cancer, their carers and health professionals who care for them. In this paper, we identify recurrent patterns of ‘discursive framing’ in the 16 interviews with health care professionals. We are particularly interested in how these frames assisted participants in constructing a professional position on what ‘cultural difference’ means for the design and delivery of cancer care services to Aboriginal people. Results.Despite geographical, organisational, disciplinary and cultural diversity, these interview participants consistently drew upon six discursive frames, which we have interpreted as eitherelidinga discussion ofdifference(‘everyone is the same’ and ‘everyone is different’) orfacilitatingthat discussion (‘different priorities,’ ‘different practices’ and ‘making difference safe’). An additional strategy appeared to actively resist either of these positions but then tended to ultimately prioritise the eliding frames. Conclusions.While none of our participants were dismissive of the idea that cultural identity might matter to Aboriginal people, their reliance upon familiar narratives about what that means for cancer care services has the potential to both symbolically and practically exclude the voices of a group of people who may already feel disenfranchised from the mainstream health care system. Critically unpacking the ‘taken for granted’ assumptions behind how health care professionals make sense of cultural difference can enrich our understanding of and response to the care needs of indigenous people affected by cancer. [ABSTRACT FROM PUBLISHER]

Hepatitis C (HCV) is a disease of the liver with a range of potentially debilitating symptoms, the severity of which differ from person to person. HCV is a major public health challenge. Globally an estimated one in 12 persons is affected by the virus, and substantial new transmissions occur each year. The vast majority of new transmissions occur among people who inject drugs, particularly through practices such as sharing of needles, syringes and other injecting equipment. Behavioural surveillance data suggest that the majority of equipment sharing occurs between intimate partners. Despite this, very little research has focussed on intimate partnerships as a site of hepatitis C transmission or prevention. This is in part because people who inject drugs are conventionally represented as lacking capacity for romantic love and intimacy; also, drug 'addiction' is produced as the antithesis of voluntarity, autonomy and authenticity, all of which feature strongly in Western understandings of romantic love. This study aims to fill existing gaps in the literature about the relationship between romantic love and injecting drug use (IDU) and to explore injecting drug practices among partners in intimate relationships. Fifteen people who inject drugs, currently in long-term heterosexual relationships, were recruited for in-depth interviews, which were recorded, transcribed verbatim and analysed thematically. The main findings of this study are that romantic love and intimacy figure prominently in the lives of people who inject drugs, and that romantic notions such as commitment, trust, care and support shape how individuals who inject drugs talk about serostatus with their partners and how they account for injecting practices. Moreover, injecting practices are co-produced within intimate relationships, shaped by perceptions of risk within and outside the relationship, ideas of intimacy, and the specific levels of skill and expertise within these relationships. These findings have important implications for harm reduction strategies, which, we suggest, have largely failed to take into account the intimate relationship as a source of practice. We conclude with suggestions for future work in this area. [ABSTRACT FROM AUTHOR]