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O estudo tem como objectivo descrever a utilização de serviços de saúde para informação, prevenção e teste do VIH por parte de homens gays em Portugal e identificar factores associados a ter efectuado o teste VIH em diferentes serviços. Para este estudo de abordagem participativa foi aplicado um inquérito por questionário a 1046 homens gays. Cerca de 27% dos participantes refere que recorreu ao CAD para obter informação sobre VIH/sida. Cerca de 83% recebeu gratuitamente preservativos no último ano. A maioria (88%) já efectuou o teste do VIH. Destes, 74% realizou‑o no SNS, 22.5% num serviço privado e 6.5% numa ONG, verificando‑se diferenças significativas quanto à idade, escolaridade, rendimento e nacionalidade. Os resultados indicam uma utilização dos serviços de saúde para informação, prevenção e teste do VIH pela maioria dos participantes. No entanto, é importante continuar a desenvolver esforços para promover a utilização dos serviços, em especial pelos grupos desta população que se encontram em maior vulnerabilidade, trabalhando em proximidade com as comunidades. This study aims to describe utilization of health services for HIV information prevention and testing by gay men in Portugal and identify factors associated with having been tested for HIV in different settings. In this study based on a participatory approach a questionnaire was applied to 1046 gay men. About 27% of participants referred to have used CAD to obtain information about HIV/Aids. Around 83% received free condoms during last year. The majority (88%) have been tested. Among these, 74% had a test in the NHS, 22.5% in a private service and 6.5% in an NGO, with significant differences regarding age, education, income and nationality. The results point to a utilization of health services for HIV information, prevention and testing among most of participants. Nevertheless, it is important to undertake efforts continuously to promote health services utilization, in particular by groups of gay men population that are in greater vulnerability, working closely with communities.

Social prescribing (SP) is an innovative approach to tackle social determinants of health. It enables general practitioners (GPs) to address non-medical causes of ill-health by linking primary care patients with non-medical community sources of support. Despite convincing results from punctual evaluations, comprehensive evaluation of SP is needed to provide guidance on what works and evidence on its impact. A SP pilot-project started in 2018 in a primary care service in Lisbon. Its implementation process and outcomes are being evaluated through a longitudinal mixed-method evaluation study assessing patients’ wellbeing, quality of life, anxiety and depression in key stages of the intervention and stakeholders’ perspectives on facilitators/barriers to the intervention implementation. GPs refer patients to a social worker of the service, who defines with the patient the individual intervention plan using community resources. Initially, GPs and social workers were trained on SP, a network of community partners was built, SP information was distributed to patients, a referral online platform was created and a baseline study is being conducted. In the 1st semester, 130 patients were referred: 39.2% were ≥65 years old, 70.8% were female, 45.4% had foreign nationality. Over two thirds were referred for multiple reasons mostly social isolation, immigration/social integration, mental health, sedentary lifestyle, access to social benefits and employment/skills training. The project has enabling to support patients with multiple complex psychosocial needs. Regular meetings between GPs and partners have improving collaboration and patients’ supervision. The participatory approach and training emerged as facilitators of the intervention. Yet, the increased burden on social workers due to growing referral profile and some stakeholders’ scepticism toward SP need to be addressed. The triangulation of sources, methods and data provide evidence on the intervention impact and scalability. Key messages The social prescribing intervention has been effective in tackling multiple social determinants of health. Intervention evaluation is being key to identify facilitators and opportunities for scale up.

Aim: This study aimed to describe perceptions and experiences related to access and utilization of health care services of African and Brazilian immigrant women in Portugal. Subjects and methods: Six focus groups were conducted with 35 African and Brazilian women with low income and living in Lisbon, chosen through purposive sampling. Content analysis was undertaken through identification of themes and categories. Results: African and Brazilian women expressed different perceptions and patterns of use of health care services. Most participants pointed out several barriers to access and utilization of services related to legal issues, economic constraints or health professionals' attitudes. Conclusion: These results highlight the challenges to providing health care within a multicultural setting and the need to assure the provision of integrated and comprehensive health care services. Improving access to general health care is essential in order to minimize disadvantages from vulnerable subgroups, like immigrant women. Supporting better integration into the health system may lead to improved health outcomes.

This study aimed to examine risky sexual behavior, its associated factors and HIV infection among immigrants. A participatory cross-sectional survey was conducted with 1187 immigrants at the National Immigrant Support Centre, in Lisbon (52.2% female; 34.0% Africans, 33.8% Brazilians, 32.2% Eastern Europeans). About 38% of participants reported ≥2 sexual partners in the previous year, 16.2% both regular and occasional sexual partners (last 12 months), 33.1% inconsistent condom use with occasional partners, and 64% no condom use in the last sexual intercourse. Unprotected sex in the last sexual intercourse was more likely among women, Africans, those older, with elementary education, those married and those who didn’t receive free condoms in the previous year. No condom use was less likely among those having only occasional sexual partners and both regular and occasional sexual partners. One third of participants had never been tested for HIV. Those never tested reported more frequently inconsistent condom use than those ever tested. Overall, 2.0% reported being HIV positive (2.5% of men; 4.4% of Africans); 4.3% admitted having a STI in previous year. HIV-positive immigrants reported high-risk sexual behaviors. Tailored interventions to promote awareness of HIV serostatus among immigrants as well as culturally adapted risk reduction strategies should be strengthened.

Background Cervical cancer claims 311,000 lives annually, and 90% of these deaths occur in low- and middle-income countries. Cervical cancer is a highly preventable and treatable disease, if detected through screening at an early stage. Governments have a responsibility to screen women for precancerous cervical lesions. Yet, national screening programmes overlook many poor women and those marginalised in society. Under-screened women (called hard-to-reach) experience a higher incidence of cervical cancer and elevated mortality rates compared to regularly-screened women. Such inequalities deprive hard-to-reach women of the full enjoyment of their right to sexual and reproductive health, as laid out in Article 12 of the International Covenant on Economic, Social and Cultural Rights and General Comment No. 22. Discussion This article argues first for tailored and innovative national cervical cancer screening programmes (NCSP) grounded in human rights law, to close the disparity between women who are afforded screening and those who are not. Second, acknowledging socioeconomic disparities requires governments to adopt and refine universal cancer control through NCSPs aligned with human rights duties, including to reach all eligible women. Commonly reported- and chronically under-addressed- screening disparities relate to the availability of sufficient health facilities and human resources (example from Kenya), the physical accessibility of health services for rural and remote populations (example from Brazil), and the accessibility of information sensitive to cultural, ethnic, and linguistic barriers (example from Ecuador). Third, governments can adopt new technologies to overcome individual and structural barriers to cervical cancer screening. National cervical cancer screening programmes should tailor screening methods to under-screened women, bearing in mind that eliminating systemic discrimination may require committing greater resources to traditionally neglected groups. Conclusion Governments have human rights obligations to refocus screening policies and programmes on women who are disproportionately affected by discrimination that impairs their full enjoyment of the right to sexual and reproductive health. National cervical cancer screening programmes that keep the right to health principles (above) central will be able to expand screening among low-income, isolated and other marginalised populations, but also women in general, who, for a variety of reasons, do not visit healthcare providers for regular screenings.

Pour nombreuses personnes âgées leur participation à la société est de plus en plus moins évidente et moins réussite pendant la vieillesse. Aux animateurs socioculturels, qui interviennent auprès de cette population, se pose le défi de contribuer pour maintenir et promouvoir la participation des personnes âgées aux activités, aux projets et dans la société.Dans ce texte, on analyse les stratégies et les pratiques que des étudiants de licence en animation socioculturelle rapportent, sur la promotion de la participation auprès de la population âgée. Les mémoires de stage élaborés par 22 étudiants ont été analysés; quelques étudiants ont aussi répondu à un questionnaire ou à un entretien. Les données recueillies permettent d’identifier 11 stratégies de promotion de la participation des personnes âgées ainsi que d’en classer les types de participation décrits. Ces données permettent aussi une discussion autour des représentations de la participation au sein de l’animation sociale et socioculturelle., For many elderly people, participating in society is increasingly less obvious and less attained in old age. Sociocultural community developers, who work with the elderly, face therefore the challenge to contribute to maintaining and promoting the participation of older people in activities, in projects and in society.In this paper, we take a sample of students of a 1st cycle degree on sociocultural community development and analyse the strategies and practices reported by them to promote participation among the elderly population. A content analysis of 22 students’ internship reports was conducted; some students also answered a questionnaire or an interview. The data collected allow us to identify 11 strategies of promoting the participation of older people and to classify the types of participation described. These data also enable a discussion about representations of participation within the sociocultural community development., Para muchas personas mayores su participación en la sociedad es cada vez menos evidente y menos conseguida durante el proceso de envejecimiento. A los animadores socioculturales, que trabajan con esta población, se plantea el desafío de contribuir a mantener y promover la participación de las personas mayores en actividades, proyectos y en la sociedad en general.En este artículo se analizan las estrategias y acciones que los estudiantes de la licenciatura en Animación Sociocultural proponen para la promoción de la participación de la población de edad avanzada. Las monografías de las prácticas desarrolladas por 22 estudiantes fueron examinadas; algunos estudiantes también respondieron a una encuesta o entrevista. Los datos recogidos permiten identificar 11 estrategias para motivar la participación de las personas mayores y para clasificar los tipos de participación descritos. Estos datos posibilitan además una discusión acerca de las representaciones de participación en la animación sociocultural.