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Os surtos de cólera têm vindo a aumentar na Região da África Oriental e Austral (AOA) desde Janeiro de 2023, com uma transmissão generalizada e alargada no Malawi e em Moçambique e surtos registados na Tanzânia, na África do Sul, no Zimbabué, no Burundi e na Zâmbia.1 Existe o risco de uma maior propagação causada pelos efeitos do ciclone Freddy, que atingiu Madagáscar, o Malawi e Moçambique em Março de 2023. Continuam a registar-se surtos na Somália, na Etiópia, no Quénia e no Sudão do Sul, onde os países estão a atravessar uma situação de seca após sucessivas estações chuvosas deficitárias.1 O contexto de resposta na AOA é complexo. Isto deve-se à escassez de recursos de saúde pública, incluindo a insuficiência de vacinas orais contra a cólera, e às múltiplas emergências de saúde pública e humanitárias simultâneas, incluindo a reemergência do poliovírus selvagem. O envolvimento da comunidade nas respostas ao surto de cólera é essencial, especialmente enquanto o impacto da COVID-19 ainda se faz presente na região, sobretudo no que tange à confiança na saúde pública e nos esforços de vacinação.2,3 O objectivo do presente guia de orientação é apoiar os Ministérios da Saúde, a UNICEF e outros parceiros de resposta na concepção e implementação de um envolvimento comunitário eficaz, centrado na comunidade e baseado em dados, para a resposta ao surto de cólera. Este guia de orientação foi redigido em abril de 2023 por Megan Schmidt-Sane e Tabitha Hrynick (IDS), com a colaboração de Stellar Murumba (Internews), Ngonidzashe Macdonald Nyambawaro (FICV), Eva Niederberger (Anthrologica), Santiago Ripoll (IDS), Nadine Beckmann (LSHTM), Mariana Palavra (UNICEF) e Rachel James (UNICEF). Este guia de orientação tem por base o trabalho anterior sobre a cólera da Social Science in Humanitarian Action Platform (SSHAP).

Les flambées épidémiques de choléra s’intensifient dans la région Afrique de l’Est et australe (ESAR) depuis janvier 2023, avec une transmission généralisée et étendue au Malawi et au Mozambique, ainsi que des flambées épidémiques signalées en Tanzanie, en Afrique du Sud, au Zimbabwe, au Burundi et en Zambie.1 Il existe un risque de propagation accrue causée par les effets du cyclone Freddy, qui a frappé Madagascar, le Malawi et le Mozambique en mars 2023. Les flambées épidémiques se poursuivent en Somalie, en Éthiopie, au Kenya et au Soudan du Sud, où les pays sont confrontés à la sécheresse suite à plusieurs saisons des pluies consécutives lors desquelles les précipitations n’ont pas été assez abondantes.1 Le contexte de riposte dans la région ESAR est complexe. Cela est dû aux ressources limitées en santé publique, y compris les pénuries de vaccins par voie orale contre le choléra, et aux nombreuses urgences sanitaires et humanitaires simultanées, y compris la réapparition du poliovirus sauvage. L’engagement communautaire dans les ripostes contre les flambées épidémiques de choléra est essentiel, en particulier lorsque l’impact de la COVID-19 continuent de se faire sentir dans la région, notamment en ce qui concerne la confiance dans la santé publique et les mesures liées à la vaccination.2,3 La présente note d’orientation a pour objectif d’aider les ministères de la Santé, l’UNICEF et d’autres partenaires de la riposte à concevoir et à mettre en œuvre un engagement communautaire efficace, axé sur la communauté et basé sur des données afin de répondre à la flambée épidémique de choléra. Cette note d’orientation a été rédigée en avril 2023 par Megan Schmidt-Sane et Tabitha Hrynick (IDS), avec la contribution de Stellar Murumba (Internews), Ngonidzashe Macdonald Nyambawaro (IFRC), Eva Niederberger (Anthrologica), Santiago Ripoll (IDS), Nadine Beckmann (LSHTM), Mariana Palavra (UNICEF), et Rachel James (UNICEF). Cette note d’orientation s’inspire de travaux antérieurs sur le choléra réalisés par la Plateforme Social Science in Humanitarian Action (SSHAP).

This special issue of Anthropology in Action presents a collection of articles that reflect on and analyse the role of social science in epidemic response. The COVID-19 pandemic has exposed deep social and economic inequalities within and across countries which produce unequal COVID-19 outcomes. Researchers have long noted the connections between socioeconomic inequalities and infections, and there is growing recognition that epidemics are also social and political events (Bardosh et al. 2020). Anthropological and other social science research has contributed to epidemic response, through attention to cultural and politico-economic context, reframing community ‘resistance’, bolstering community engagement in preparedness and response, and informing response activities, including risk communication (Abramowitz 2017; Bardosh et al. 2020). Despite this, much of the work has been ad hoc and not systematically integrated into the systems of epidemic response, with the exception of the Centres d’Analyses des Sciences Sociales (CASS) in the Democratic Republic of Congo (DRC). This special issue is timely, in that it builds on foundational work in social science and epidemic response, draws on tensions and experience from recent epidemics including COVID-19 and Ebola, and charts a way forward at both a theoretical and a practical level.

In epidemic preparedness and response, it is now commonly accepted that insights from social science disciplines are important in shaping action. Unfortunately, the role of social science is often confined to risk communication and community engagement (RCCE) efforts. In this article, we propose an analytical framework that would allow researchers and practitioners from different disciplines to employ social science insights to enrich their understanding of epidemics and formulate more effective and sustainable responses. The framework goes beyond simply unpacking social, political, economic and cultural dimensions of context; it situates disease itself – as it is shaped by the contexts in which it circulates – and views it in dynamic relation to response. It also explores how different individuals, social groups and institutions shift their knowledge and practices during an epidemic through power-laden processes of dialogue and learning, or even through silencing and side-lining. It is our hope that this framework will enable responders to engage more deeply and systematically with the contexts of emergencies, so as to ensure activities are more adaptive to local dynamics.

Cholera outbreaks have been on the rise in the East and Southern Africa Region (ESAR) since January 2023, with widespread and extended transmission in Malawi and Mozambique and outbreaks reported in Tanzania, South Africa, Zimbabwe, Burundi, and Zambia.1 There is risk of further spread caused by the effects of Cyclone Freddy, which hit Madagascar, Malawi, and Mozambique in March 2023. Outbreaks are continuing in Somalia, Ethiopia, Kenya, and South Sudan, where countries are experiencing drought after multiple failed rainy seasons.1 The response context in ESAR is complex. This is due to the strained public health resources, including shortages of oral cholera vaccines, and the multiple concurrent public health and humanitarian emergencies, including the re-emergence of wild poliovirus. Community engagement in cholera outbreak responses is essential, especially while the impact of COVID-19 continues to be felt in the region, particularly on trust in public health and vaccination efforts.2,3 The purpose of this guidance note is to support Ministries of Health, UNICEF, and other response partners to design and implement effective, community-centred, and data-driven community engagement for cholera outbreak response. This guidance note was written in April 2023 by Megan Schmidt-Sane and Tabitha Hrynick (IDS), with input from Stellar Murumba (Internews), Ngonidzashe Macdonald Nyambawaro (IFRC), Eva Niederberger (Anthrologica), Santiago Ripoll (IDS), Nadine Beckmann (LSHTM), Mariana Palavra (UNICEF), and Rachel James (UNICEF). This guidance note draws on the Social Science in Humanitarian Action Platform (SSHAP)'s past work on cholera.

The cost of the Covid-19 pandemic remains unknown. Lives directly lost to the disease continue to mount, while related health, livelihood and wellbeing impacts are still being felt, and the wider ramifications across society, politics and the economy are yet to fully materialise. What is known about these costs though, is that they have been unequally distributed both within and between countries. Preparedness plans proved inadequate in many settings – especially when it came to protecting those most vulnerable, including those marginalised by geography, poverty, or exclusion along the lines of religion, ethnicity or gender. The top-down, surge-style, biomedically dominated and technologically driven preparedness approach that has dominated global health thinking and which was propelled into action with Covid-19 was found wanting not only on the grounds of effectiveness, but also of social justice. This presents both a challenge and an opportunity for a convergence of the preparedness and development agendas. Drawing on a growing body of social science evidence, this report contends that securing health in the face of today’s uncertain disease threats in often unpredictable settings means making social, economic and political priorities as core to the preparedness agenda as biological and technological ones. We present here a framework for a vision of pandemic preparedness for the real world – one that accepts that context is paramount, embraces inclusivity and justice, shifts power centres and rejects simplistic, one-size-fits-all solutions.

Si l’on s’en tient aux chiffres de la vaccination contre la COVID-19 dans les pays du G7, la campagne apparaît comme un véritable succès tant au niveau global qu’au niveau national. En effet, à ce jour, 79,4 % de la population totale des pays du G7 a reçu une première dose, 72,9 % une seconde, et 45,4 % une dose de rappel (données du 28 avril 2022) 1 En France, c’est 80,6 % de la population totale qui a reçu une première dose, 78,2 % qui a reçu deux doses, et 55,4 % qui a reçu un rappel (données du 28 avril 2022).2 Au Royaume-Uni, 79,3 % de la population totale a reçu une première dose, 74,1 % une seconde, et 58,5 % un rappel.1 Enfin, en Italie, 85,2 % de la population totale a reçu une première dose, 80,4 % a reçu deux doses et 66,5 % a reçu leurs rappels (données du 28 avril 2022). Ces taux de vaccination élevés masquent pourtant des disparités importantes à l’intérieur de chaque pays. Ainsi, à Marseille, deuxième ville de France, moins de 50 % des habitants des quartiers nord de la ville étaient vaccinés à la fin de l’année 2021, alors que plus de 70 % des habitants des quartiers sud l’étaient au même moment.3 Dans le quartier populaire de Ealing, situé au nord-ouest de Londres, 70 % de la population admissible avait reçu une première dose, soit près de 10 % de moins que la moyenne nationale. 4 (Données du 4 avril 2022). Des disparités similaires ont été observées dans d’autres métropoles urbaines des pays du G7. Ce document examine ces disparités au prisme de la notion d’« (in)égalité vaccinale ». En s’appuyant sur des recherches qualitatives menées pendant la campagne de vaccination de la COVID-19 dans les quartiers nord de Marseille, le quartier de Ealing à Londres (Nord-ouest) et dans la région de l'Émilie-Romagne et à Rome, en Italie, il montre comment les autorités locales peuvent agir pour atténuer ces inégalités. Mieux comprendre les inégalités en matière de vaccins fut primordial lors de la pandémie de la COVID-19 en ce sens que les populations sous-vaccinées étaient la plupart du temps des minorités ethniques ou culturelles, vivant dans des zones défavorisées, ou sans-papiers, donc plus susceptibles de contracter la COVID-19, et d’en subir les conséquences les plus dramatiques. 5 6 7 8 Ainsi, à Ealing, quatre mois après la campagne de vaccination, seulement 57,6% des personnes dans le décile de pauvreté le plus bas avaient reçu une dose, contre 81% des personnes dans le décile le plus aisé. 9 En outre, 89,2 % des résidents britanniques blancs de Ealing étaient vaccinés, contre 64 % des Pakistanais et 49,3 % des habitants issus des Caraïbes.9 À Rome, comme c’est le cas dans d’autres métropoles urbaines des pays du G7, nos données révèlent des disparités particulières importantes entre le recours aux vaccins des populations sans papiers et celui des citoyens établis. Les facteurs d’inégalité vaccinale dans ces environnements urbains sont complexes et liés à l’interaction de nombreux phénomènes tels que les inégalités économiques, le racisme structurel, l'inégalité d'accès aux soins de santé, la méfiance envers les professionnels de santé, les représentants de l'État, et plus encore. Les collectivités locales tout comme les professionnels de la santé, les groupes communautaires et les résidents jouent un rôle clé dans la manière dont s’exprime l’(in)égalité vaccinale. Pour autant, peu de leçons ont été systématiquement tirées des efforts menés en matière d’ «engagement vaccinal » au niveau local. Dans ce document, nous proposons d’expliquer comment l’expérience des inégalités structurelles se recoupe avec celle des habitants, et comment ces expériences ont été prises en compte ou au contraire ignorées dans la promotion et l’administration des vaccins contre la COVID-19 par les collectivités locales. Nous adressons également un ensemble de recommandations qui s’appliquent aux programmes de « vaccination de rattrapage » contre la COVID-19 (visant à atteindre les personnes qui n’ont pas encore reçu leur schéma vaccinal complet), mais elles concernent également les programmes de vaccination d'urgence à venir. Ce document repose sur des recherches menées entre octobre et décembre 2021 à Marseille et sur des échanges réguliers avec les autorités du Borough de Ealing initiés dès mai 2021. Il identifie comment les gouvernements locaux, les acteurs de la santé, les groupes communautaires et les résidents jouent un rôle clé dans la production d’(in)égalités vaccinales. Ce document a été élaboré pour la SSHAP par Santiago Ripoll (IDS), Tavitha Hrynick (IDS), Ashley Ouvrier (LaSSA), Megan Schmidt-Sane (IDS), Federico Federici (UCL) et Elizabeth Storer (LSE). Il a été revu par Eloisa Franchi (Université de Pavie) et Ellen Schwartz (Conseil de santé publique de Hackney). La recherche a été financée par la British Academy COVID-19 Recovery : Fonds G7 (COVG7210038). Les recherches ont été menées à l’Institut d’études du développement (IDS), à l’Université de Sussex et au Laboratoire des sciences sociales appliquées (LaSSA). La SSHAP en assume la responsabilité.

On 20 September 2022, an outbreak of the Sudan strain of Ebola Virus Disease – SVD – was announced as the first laboratory-confirmed patient was identified in a village in Mubende District in central Uganda. Uganda’s Ministry of Health (MoH) activated the National Task Force and developed and deployed a National Response Plan, which includes the activation of District Task Forces. The target areas include the epicentre (Mubende and Kassanda districts) and surrounding areas, as well as Masaka, Jinja and Kampala cities. This is of great concern, as Kampala is the capital city with a high population and linkages to neighbouring districts and international locations (via Entebbe Airport). It is also a serious matter given that there has been no outbreak of Ebola before in the city. This brief details how Risk Communication and Community Engagement (RCCE) activities and approaches can be adapted to reach people living in Greater Kampala to increase adoption of preventive behaviours and practices, early recognition of symptoms, care seeking and case reporting. The intended audiences include the National Task Force and District Task Forces in Kampala, Mukono, and Wakiso Districts, and other city-level RCCE practitioners and responders. The insights in this brief were collected from emergent on-the-ground observations from the current outbreak by embedded researchers, consultations with stakeholders, and a rapid review of relevant published and grey literature. This brief, requested by UNICEF Uganda, draws from the authors’ experience conducting social science research on Ebola preparedness and response in Uganda. It was written by David Kaawa-Mafigiri (Makerere University), Megan Schmidt-Sane (Institute of Development Studies (IDS)), and Tabitha Hrynick (IDS), with contributions from the MoH, UNICEF, the Center for Health, Human Rights and Development (CEHURD), the Uganda Harm Reduction Network (UHRN), Population Council and CLEAR Global/Translators without Borders. It includes some material from a SSHAP brief developed by Anthrologica and the London School of Economics. It was reviewed by the Uganda MoH, University of Waterloo, Anthrologica, IDS and the RCCE Collective Service. This brief is the responsibility of SSHAP.

This study reports on findings from a youth participatory action research of children's well-being and health. We draw upon the Social Determinants of Health framework, including a focus on structural racism and intersectionality, to holistically explore the ways in which youth (ages 13-17) experience multiple forms of marginalization within the neighborhood, and how these experiences influence their well-being outcomes. We employed the data collection techniques of focus group discussion, community mapping, photovoice, and follow-up small group discussions with 14 African American youth in Cleveland, Ohio. Utilizing participatory thematic analysis, the participants established four main thematic categories connected to the neighborhood which have a strong influence on youth health and well-being. These categories included: (1) Crime and safety; (2) Housing and the built environment; (3) Social Influence; (4) Community Activities. By involving youth as co-constructors of the research, we elicited perspectives on the pathways between a healthy neighborhood to healthy residents, with implications for future research, policy, and intervention programming aimed at improving the health and well-being of children and youth.

Despite progress in COVID-19 vaccination rates overall in the US and UK, vaccine inequity persists as young people from minoritised and/or deprived communities are often less likely to be vaccinated. COVID-19 ‘vaccine hesitancy’ is not just an issue of misinformation or lack of information. ‘Vaccine hesitancy’ among young people is reflective of wider issues such as mistrust in the state or the medical establishment and negative experiences during the pandemic. This report is based on case study research conducted among young people (ages 12-18) in Cleveland, Ohio, US and the London borough of Ealing, UK. Whilst public discourse may label young people as ‘vaccine hesitant,’ we found that there were differences based on social location and place and this labelling may portray young people as ‘ignorant.’ We found the greatest vaccine hesitancy among older youth (15+ years old), particularly those from minoritised and deprived communities. Unvaccinated youth were also more likely to be from families and friend groups that were unvaccinated. While some expressed distrust of the vaccines, others reported that COVID-19 prevention was not a priority in their lives, but instead concerns over food security, livelihood, and education take precedence. Minoritised youth were more likely to report negative experiences with authorities, including teachers at their schools and police in their communities. Our findings demonstrate that COVID-19 vaccine hesitancy is embedded in a context that drives relationships of mistrust between minoritised and deprived communities and the state, with implications for COVID-19 vaccine uptake. Young people’s attitudes toward vaccines are further patterned by experiences within their community, school, family, and friend groups.

The COVID-19 pandemic has greatly altered the lives of children and youth throughout the world, with significant implications for their long-term health and well-being. Children were largely excluded from the development and implementation of the various pandemic mitigation strategies and policies, yet their lives were significantly affected. This study sought to shed light on children's perspectives and experiences during the COVID-19 pandemic, the various ways it impacted their health and well-being, along with the resources which allowed them to continue to flourish in the face of extreme hardship. We present a subset of findings regarding the COVID-19 pandemic from the

The global pandemic has brought renewed attention toward the everyday challenges in informal settlements. COVID-19 reminds us that southern urban life is rooted in ‘collective’ experiences where toilets and kitchens are shared by multiple families; where the categories of work and home, private and public space overlap; and where the majority live in vulnerable conditions. Despite these challenges, some of the most innovative and collective responses to COVID-19 have emerged from these areas. While informal settlements did face a host of risks and vulnerabilities during the pandemic, local responses have highlighted the resilience of informal settlement communities. However, few informal settlements are actually ‘resilient’ and any local responses must be robustly supported by system-wide change including support from local and national governments, improvements to built infrastructure, and improved access to health care services, among other priorities. The category of ‘informal settlements’ also captures a wide range of settlement types, from a legal slum to an informal settlement with no legal status, with many other types in between. This underscores the need to address fundamental issues that ‘perpetuate conditions of inequity, exclusion and vulnerability’ while also recognising the needs and contexts of different kinds of informal settlements. Whether COVID-19 helps governments recognise conditions of insecurity and vulnerability to address safe and secure housing and infrastructures remains to be seen. This is an update to the previous SSHAP brief on ‘COVID-19 in Informal Urban Settlements’ (March 2020). This evidence review highlights local responses, grassroots efforts, and challenges around COVID-19 recovery within urban informal settlements in South Asia. It focuses on specific examples from Karachi, Pakistan and Mumbai, India to inform policy responses for COVID-19 recovery and future epidemic preparedness and response. We show how local level responses are shaped in these cities where national and international responses have not reached communities at municipal and sub-municipal levels. This brief was written by Saba Aslam (IDS Alumni) and Megan Schmidt-Sane (IDS), with reviews from Professor Amita Bhide (Tata Institute of Social Sciences, India), Dr Asad Sayeed (Collective for Social Science Research, Pakistan), Annie Wilkinson (IDS), and contributions from Swati Mishra (LSHTM), Prerana Somani (LSHTM), Saleemullah Odho (Deputy Commissioner, Korangi district Karachi), Dr Noman Ahmed (NED University, Karachi), Tahera Hasan (Imkaan Foundation, Karachi), Atif Khan (District Health Officer, Korangi district Karachi), Dr Harris (District Focal person, Korangi), Aneeta Pasha (Interactive for Research and Development, Karachi), Yasmeen Shah (Pakistan Fisherfolk Forum), Ghulam Mustafa (HANDS Pakistan), and Dr Shehrin Shaila Mahmood (icddr,b). This brief is the responsibility of SSHAP.

Given the health, social, and economic upheavals of the COVID-19 pandemic, there is understandable anxiety about another virus, monkeypox, quickly emerging in many countries around the world. In West and Central Africa, where the disease has been endemic for several decades, monkeypox transmission in humans usually occurs in short, controllable chains of infection after contact with infected animal reservoirs. Recent monkeypox infections have been identified in non-endemic regions, with most occurring through longer chains of human-to-human spread in people without a history of contact with animals or travel to endemic regions. These seemingly different patterns of disease have prompted public health investigation. However, ending chains of monkeypox transmission requires a better understanding of the social, ecological and scientific interconnections between endemic and non-endemic areas. This brief is intended to be read in conjunction with the companion brief entitled ‘Social Considerations for Monkeypox Response’.1 In this set of briefs, we lay out social considerations from previous examples of disease emergence to reflect on 1) the range of response strategies available to control monkeypox, and 2) specific considerations for monkeypox risk communication and community engagement (RCCE). These briefs are intended to be used by public health practitioners and advisors involved in developing responses to the ongoing monkeypox outbreak, particularly in non-endemic countries. This brief on RCCE strategies for monkeypox response was written by Megan Schmidt-Sane (IDS), Syed Abbas (IDS), Soha Karam (Anthrologica), and Jennifer Palmer (LSHTM), with contributions from Hayley MacGregor (IDS), Olivia Tulloch (Anthrologica), and Annie Wilkinson (IDS). It was reviewed by Will Nutland (The Love Tank CIC/PrEPster) and was edited by Victoria Haldane (Anthrologica). This brief is the responsibility of SSHAP.

Given the health, social, and economic upheavals of the COVID-19 pandemic, there is understandable anxiety about another virus, monkeypox, quickly emerging in many countries around the world. In West and Central Africa, where the disease has been endemic for several decades, monkeypox transmission in people usually happens in short, controllable chains of infection after contact with infected animal reservoirs. Recent monkeypox infections have been identified in non-endemic regions, with most occurring through longer chains of human-to-human spread in people without a history of contact with animals or travel to endemic regions. These seemingly different patterns of disease have prompted public health investigation. However, ending chains of monkeypox transmission requires a better understanding of the social, ecological and scientific interconnections between endemic and non-endemic areas. In this set of companion briefs, we lay out social considerations from previous examples of disease emergence to reflect on 1) the range of response strategies available to control monkeypox, and 2) specific considerations for monkeypox risk communication and community engagement (RCCE). We aim for these briefs to be used by public health practitioners and advisors involved in developing responses to the ongoing monkeypox outbreak, particularly in non-endemic countries. This brief on social considerations for monkeypox response was written by Syed Abbas (IDS), Soha Karam (Anthrologica), Megan Schmidt-Sane (IDS), and Jennifer Palmer (LSHTM), with contributions from Hayley MacGregor (IDS), Olivia Tulloch (Anthrologica), and Annie Wilkinson (IDS). The brief was reviewed by Boghuma Titanji (Emory University School of Medicine). This brief is the responsibility of SSHAP.

Despite overall progress in COVID-19 vaccination rates in Cleveland, vaccine inequity persists as young people from minority communities are often less likely to be vaccinated. COVID-19 vaccine hesitancy is not just an issue of misinformation or lack of information. Vaccine hesitancy among young people is reflective of wider issues such as mistrust in the state or the medical establishment and negative experiences during the pandemic. This report is based on case study research conducted among minority youth (ages 12-18) in Cleveland, Ohio. While public discourse may label young people as “vaccine hesitant,” we found that there were hesitation differences based on social location and place. We found the greatest vaccine hesitancy among older youth (15+ years old), particularly those from minoritized communities. Unvaccinated youth were also more likely to be from families and friend groups that were unvaccinated. While some expressed distrust of the vaccines, others reported that COVID-19 prevention was not a priority in their lives. Instead, concerns over food security, livelihood, and education take precedence. Minority youth were more likely to report negative experiences with authorities, including teachers at their schools and police in their communities. Our findings demonstrate that COVID-19 vaccine hesitancy is embedded in a context that drives relationships of mistrust between minority communities and authorities, with implications for COVID-19 vaccine uptake. Young people’s attitudes toward vaccines are further patterned by experiences within their community, school, family, and friend groups.

This brief explains youth perceptions of COVID-19 vaccination and outlines key considerations for engaging with and building trust among young people living in Ealing, London. Within the category of ‘young people,’ there are differences in vaccination based on age and ethnicity. This brief is based on research, including a review of the literature and in-depth interviews and focus groups with 62 youth across Ealing to contextualise youth perspectives of COVID-19 vaccination and highlight themes of trust/distrust. We contribute ethnographic and participatory evidence to quantitative evaluations of vaccine roll-out. Key considerations for addressing youth distrust regarding the COVID-19 vaccine are presented, followed by additional regional context. This work builds on a previous SSHAP brief on vaccine equity in Ealing. This brief was produced by SSHAP in collaboration with partners in Ealing. It was authored by Megan Schmidt-Sane (IDS), Tabitha Hrynick (IDS), Jillian Schulte (Case Western Reserve University), Charlie Forgacz-Cooper (Youth Advisory Board), and Santiago Ripoll (IDS), in collaboration with Steve Curtis (Ealing Council), Hena Gooroochurn (Ealing Council), Bollo Brook Youth Centre, and Janpal Basran (Southall Community Alliance), and reviews by Helen Castledine (Ealing Public Health), Elizabeth Storer (LSE) and Annie Wilkinson (IDS). The research was funded through the British Academy COVID-19 Recovery: USA and UK fund (CRUSA210022). Research was based at the Institute of Development Studies. This brief is the responsibility of SSHAP.

This brief explains youth perceptions of COVID-19 vaccination and outlines key considerations for engaging with and building trust among young people living in Ealing, London. Within the category of ‘young people,’ there are differences in vaccination based on age and ethnicity. This brief is based on research, including a review of the literature and in-depth interviews and focus groups with 62 youth across Ealing to contextualise youth perspectives of COVID-19 vaccination and highlight themes of trust/distrust. We contribute ethnographic and participatory evidence to quantitative evaluations of vaccine roll-out. Key considerations for addressing youth distrust regarding the COVID-19 vaccine are presented, followed by additional regional context. This work builds on a previous SSHAP brief on vaccine equity in Ealing. This brief was produced by SSHAP in collaboration with partners in Ealing. It was authored by Megan Schmidt-Sane (IDS), Tabitha Hrynick (IDS), Jillian Schulte (Case Western Reserve University), Charlie Forgacz-Cooper (Youth Advisory Board), and Santiago Ripoll (IDS), in collaboration with Steve Curtis (Ealing Council), Hena Gooroochurn (Ealing Council), Bollo Brook Youth Centre, and Janpal Basran (Southall Community Alliance), and reviews by Helen Castledine (Ealing Public Health), Elizabeth Storer (LSE) and Annie Wilkinson (IDS). The research was funded through the British Academy COVID-19 Recovery: USA and UK fund (CRUSA210022). Research was based at the Institute of Development Studies. This brief is the responsibility of SSHAP.

Despite progress in COVID-19 vaccination rates overall in Cleveland, vaccine inequity persists as young people from minoritised communities are often less likely to be vaccinated. Despite being over-represented in COVID-19 case counts and fatalities, Black residents were under-represented in COVID-19 vaccination during the first year and half of the pandemic. In Ohio, while roughly 60% of Cuyahoga County residents are fully vaccinated, just 45% of Cleveland residents are fully vaccinated. Lower-income, majority Black, east side neighbourhoods have markedly lower vaccination rates compared to higher-income, mostly white neighbourhoods. Young people ages 16-40 became eligible for the COVID-19 vaccine on March 29th, 2021, and individuals aged 12 and above were able to get vaccinated from May 2021 onward. However, large disparities exist based age, race, and zip code. This brief illustrates underlying reasons shaping COVID-19 vaccine attitudes among minority (especially Black and Latinx) youth (ages 12-18) and offers key considerations for how young people can be better engaged within Cleveland, Ohio. This brief is based on research, including in-depth interviews and focus group discussions with 61 young people across 16 neighbourhoods through a Youth Participatory Action Research (YPAR) approach in Cleveland to contextualise youth perspectives of COVID-19 vaccination and highlight areas of hesitancy and confidence. In this brief, we share findings from the study and key considerations for addressing youth ‘vaccine hesitancy’ around the COVID-19 vaccine are presented. This brief was authored by Jillian Schulte (Case Western Reserve University), Megan Schmidt-Sane (IDS), Elizabeth Benninger (Cleveland State University), Tabitha Hrynick (IDS), and Santiago Ripoll (IDS), and includes contributions from Elizabeth Davies (Cleveland State University), Diane Mastnardo, Brenda Pryor (MyCom), Brinda Athreya (Case Western Reserve University), Ivis Maldonado (MyCom) and reviews from Elizabeth Storer (LSE) and Annie Wilkinson (IDS). The research was funded through the British Academy COVID-19 Recovery: USA and UK fund (CRUSA210022). Research was based at the Institute of Development Studies. This brief is the responsibility of SSHAP.

At national and aggregate levels, COVID-19 vaccination across G7 countries appears successful. To date, 79.4% of the total population of G7 countries have received a first dose, 72.9% a second, and 45.4% a booster shot (28th April 2022 data). In France, 80.6% of the total population has had a first dose, 78.2 % have had two doses, and 55.4% have had their booster jabs (28th of April 2022 data). In the UK, 79.3% of the total population has received one dose, 74.1% a second one, and 58.5% have received a booster. In Italy, 85.2% of the total population has had a first dose, 80.4% have had two doses, and 66.5% have had their booster jabs (28th of April 2022 data). These figures indicate enthusiasm across G7 countries for COVID-19 vaccines. Yet high overall vaccination rates at the national level, disguise significant in-country disparities. For example, by the end of 2021, less than 50% of residents of the Northern Districts of Marseille were vaccinated, compared with over 70% in wealthier neighbourhoods. In the Ealing borough of Northwest London, 70% of the eligible population has had a first dose – which is almost 10% percent below the national average (4th of April 2022 data). Disparities are also seen in other urban metropolises across the G7. This brief investigates these disparities through the lens of “vaccine (in)equity”, focusing on the role of local actors. It builds on ethnographic and qualitative research carried out in the Northern Districts of Marseille and ongoing research engagement around vaccine equity in Ealing (Northwest London), as well as qualitative research carried out in Italy among networks of healthcare providers, intercultural mediators, and civil society organizations that collaborated during the COVID-19 campaign in the Emilia Romagna region and in Rome. This brief is based on research conducted between October and December 2021 in Marseille and ongoing engagement in Ealing which started in May 2021. It identified how local governments, health actors, community groups and residents play key roles in shaping vaccine (in)equity. This brief was developed for SSHAP by Santiago Ripoll (IDS), Tabitha Hrynick (IDS), Ashley Ouvrier (LaSSA), Megan Schmidt-Sane (IDS), Federico Federici (UCL) and Elizabeth Storer (LSE). It was reviewed by Eloisa Franchi (Università degli Studi di Pavia) and Ellen Schwartz (Hackney Council Public Health). The research was funded through the British Academy COVID-19 Recovery: G7 Fund (COVG7210038). Research was based at the Institute of Development Studies (IDS), University of Susssex, and the Laboratoire de Sciences Sociales Appliquées (LaSSA). The brief is the responsibility of SSHAP.

Embedded within the COVID-19 pandemic is the spread of a new pandemic of information – some accurate, some not – that can challenge the public health response. This has been termed an ‘infodemic’ and infodemic management is now a major feature of the World Health Organization’s work on health emergencies. This commentary highlights political, social, and economic aspects of infodemics and posits social science as critical to mitigating the current infodemic and preventing future ones. Infodemic managers should address the wider context of infodemics if we are to understand narratives, help to craft positive ones, and confront the root causes of misinformation rather than just the symptoms.

On 25 November 2021, the CORE Knowledge Translation Services team at the Institute of Development Studies, UK, hosted an online clinic session to facilitate the sharing of experiences and mutual learning on how CORE projects have or can adapt their research activities in the context of the Covid-19 pandemic. The clinic was attended by 22 CORE members from 12 projects and featured contributions from two CORE projects: The Youth Question in Africa: Impact, Response and Protection Measures in the IGAD Region and A New Digital Deal for an Inclusive Post-Covid-19 Social Compact: Developing Digital Strategies for Social and Economic Reconstruction. This learning guide captures the practical insights and advice from the event, to help inform the practice of participants and other projects across the portfolio.

This study examined the context and drivers of HIV risk and vulnerability among male partners of female sex workers in Kampala, Uganda, using an "intersectional risk environment" framework.This research reports on findings from an ethnographic study (2016-2019) of men in one informal settlement in Kabalagala Parish in Kampala. This research included long-term participant observation in and around the study community. Thematic analysis was used to assess aspects of the risk environment and how it influences HIV/AIDS among male partners of female sex workers.The informal settlement context where sex work takes place is conceptualized here as a "risk environment," or a social-physical space in which risk and harm are produced (Rhodes, 2002). Risk is situated within a broader social and political structure that constrains choices and facilitates HIV risk, particularly for young, low-income men facing matrices of domination on the basis of age, gender, residence, and income. These intersectionalities guide experiences of HIV vulnerability in the risk environment, including physical, social, economic, and policy risks. This includes physical risks (population density, bar density), social risks (sex work, bar groups), economic risks (informal and low wage work), and political risks (anti-poverty laws and legislation, urban policy).These findings highlight how an intersectional risk environment is differentially experienced by young, low-income men to produce unequal HIV/AIDS outcomes. This research fills a gap in the literature on the context of HIV/AIDS among men, particularly high-risk men like male partners of female sex workers. Using this framework will improve understandings of HIV outcomes among male partners of female sex workers and will facilitate context-specific and adapted structural interventions for HIV/AIDS prevention and treatment.

Access to fresh and healthy food within a neighborhood has been identified as a social mechanism contributing to community health. Grounded in the understanding that challenges related to equity within a food system are both structural and systemic, our research demonstrates how systems thinking can further understandings of food system complexity. Within systems thinking, we provide an illustration of how system archetypes offer an analytic tool for examining complex community issues. We map semi-structured interview data from community stakeholders (N = 22) to the "Fixes that Fail" system archetype to illuminate systemic challenges, such as incarceration and poverty, that structure food system inequity in urban communities. Within our research, the "Fixes that Fail" archetype provided a narrative interpretive tool for unveiling complexity within the food system and interdependencies with racialized systems such as criminal justice and labor markets. This system archetype provided an accessible approach for generating narratives about systemic complexity, the production of inequity through racialized forces, and opportunities for transformation.

The COVID-19 response continues to be driven by epidemiological priorities, and yet, the epidemic and responses are situated within specific political and health system contexts. Social science brings an understanding of context and draws attention to politics, power and social difference. There are four critical social science priorities for COVID-19 research and policy in the long term. First, political-economic insights can support the design of public health measures and elucidate how public health responses are produced by political systems. Second, a better understanding of the political and social structures that relate to vaccine confidence will improve public trust, acceptability, effectiveness and uptake of COVID-19 vaccines and therapeutics. Third, development of social science perspectives on health and governance is vital to inform and untangle the complicated ways in which nationalism interacts with public health measures. Finally, social science inquiry can reveal how individuals and communities perceive, understand and construct COVID-19 risk and severity and seek help. These insights support building trust and good relations between local and international research and programme teams and between communities and researchers that will enhance confidence in the development, research and deployment of vaccines and other COVID-19 control measures.

Since February 2021, countless lives have been lost in India, which has compounded the social and economic devastation caused by the second wave of COVID-19. The sharp surge in cases across the country overwhelmed the health infrastructure, with people left scrambling for hospital beds, critical drugs, and oxygen. As of May 2021, infections began to come down in urban areas. However, the effects of the second wave continued to be felt in rural areas. This is the worst humanitarian and public health crisis the country has witnessed since independence; while the continued spread of COVID-19 variants will have regional and global implications. With a slow vaccine rollout and overwhelmed health infrastructure, there is a critical need to examine India's response and recommend measures to further arrest the current spread of infection and to prevent and prepare against future waves. This brief is a rapid social science review and analysis of the second wave of COVID-19 in India. It draws on emerging reports, literature, and regional social science expertise to examine reasons for the second wave, explain its impact, and highlight the systemic issues that hindered the response. This brief puts forth vital considerations for local and national government, civil society, and humanitarian actors at global and national levels, with implications for future waves of COVID-19 in low- and middle-income countries. This review is part of the Social Science in Humanitarian Action Platform (SSHAP) series on the COVID-19 response in India. It was developed for SSHAP by Mihir R. Bhatt (AIDMI), Shilpi Srivastava (IDS), Megan Schmidt-Sane (IDS), and Lyla Mehta (IDS) with input and reviews from Deepak Sanan (Former Civil Servant; Senior Visiting Fellow, Centre for Policy Research), Subir Sinha (SOAS), Murad Banaji (Middlesex University London), Delhi Rose Angom (Oxfam India), Olivia Tulloch (Anthrologica) and Santiago Ripoll (IDS). It is the responsibility of SSHAP.

भारत में फ़रवरी 2021 से अनगिनत जानों की हानि हुई है जिसने कोविड-19 द्वारा हुए सामाजिक और आर्थिक प्रलय को बढ़ा दिया है । देश भर में तीव्र गति से बढ़ते संक्रमित मामलों ने बुनियादी स्वास्थ्य ढाँचे को हिला दिया है, जिससे आम आदमी अस्पताल में बिस्तर, आवश्यक दवाइयों और ऑक्सिजन के लिए हाथ पांव मरने के लिए मजबूर हो गया । मई 2021 तक शहरों में संक्रमण का प्रभाव कम होना शुरू हुआ। हालाँकि गाँवों में दूसरी लहर का प्रकोप जारी है । आज़ादी के बाद देश सबसे बड़ी और बुरी मानवीय तथा सार्वजनिक स्वास्थ्य संकट का साक्षी बना है, जबकि क्षेत्रीय और वैश्विक स्तर पर लगातार फैलते हुए कोविड-19 प्रकारों के विविध परिणाम होंगे । धीमी गति से शुरू हुआ टीका करण अभियान और स्वास्थ्य सेवायों पर अत्यधिक भार को देखते हुए, भारत की प्रतिक्रिया, संक्रमण को और फैलने से रोकने के लिए उपायों की योजना, भविष्य के लहरों के खिलाफ तैयारी, की जाँच करने की बहुत अधिक ज़रूरी है । यह संक्षिप्त भारत में आई कोविड-19 की दूसरी लहर का सामाजिक विज्ञान समीक्षा व विश्लेषण है । यह दूसरी लहर की जाँच हेतु उदीयमान रिपोर्ट्स, साहित्य, क्षेत्रीय सामाजिक विज्ञान का एक चित्र खींचता है, उसका प्रभाव समझाता है, और उन सभी व्यवस्थित मुद्दों को उभरता है जो सही प्रतिक्रिया देने में रुकावट सिद्ध हुए । यह संक्षिप्त वैश्विक और राष्ट्रीय स्तर पर स्थानीय और राष्ट्रीय सरकार, नागरिक समाज और मानवतावादी विचारकों के लिए महत्वपूर्ण चिंतन रखता है, जिसमें लघु और मध्यम आय वाले देशों में कोविड-19 की भावी लहरों के लिए निहितार्थ हैं । यह समीक्षा भारत में कोविड-19 प्रतिक्रिया पर सोशीयल सायन्स इन ह्युमेनीटेरीयन एक्शन प्लेटफोर्म (SSHAP संक्षिप्त) का हिस्सा है । इसे मिहिर आर. भट्ट (ए.आई.डी.एम.आई.), शिल्पी श्रीवास्तव (आई.डी.एस.), मेगन श्मिट-साने (आई.डी.एस.), और लैला मेहता (आई.डी.एस.) द्वारा दीपक सानन (पूर्व सिविल सर्वेंट, सीनियर विजिटिंग फेलो, सेंटर फॉर पॉलिसी रिसर्च), सुबीर सिन्हा (एस.ओ.ए.एस.), मुराद बानाजी (मिडलसेक्स यूनिवर्सिटी लंदन), रोज एंगोम (ऑक्सफैम इंडिया), ओलिविया तुलोच (एंथ्रोलोजिका), और सैंटियागो रिपोल (आई.डी.एस.) से इनपुट और समीक्षा के साथ एस.एस.एस.ए.पी. के लिए विकसित किया गया था । यह एस.एस.एच.ए.पी. की जिम्मेवारी है ।

The Covid-19 pandemic is more than a health crisis. It has worse outcomes among individuals with co-morbidities, has exposed fault lines in our societies, and amplified existing inequalities. This article draws on emerging evidence from low- and middle-income contexts to highlight how Covid-19 becomes syndemic when it interacts with local vulnerabilities. A syndemic approach provides a frame for understanding how Covid-19 is amplified when clustered with other diseases and how this clustering is facilitated by contextual and social factors that create adverse conditions. Public health responses to Covid-19 have also exacerbated these adverse conditions as many face social and economic crises as a result of some policies. These multiple challenges generate major implications for both the public health response and for broader development action: first, one size does not fit all and we must attend to local vulnerabilities; second, short-term public health response and longer-term development approaches must be integrated for improved intersectoral coordination and synergy. A synergised public health and development response will allow us to better prepare for the next pandemic.

Indigenous peoples have experienced heightened vulnerability during the COVID-19 pandemic and face disproportionately high COVID-19 mortality. To better address these vulnerabilities, it is critical to adapt COVID-19 programmes to the particular needs of indigenous peoples, as articulated by indigenous voices. It is also vital to link up with responses already ongoing and led by indigenous peoples to mitigate this crisis. This SSHAP brief discusses key considerations for COVID-19 response and recovery, with a particular focus on the Amazon region of South America. The considerations in this brief are drawn from a review of evidence and insights provided by indigenous leaders and researchers from several different continents. The considerations are rooted in key principles for indigenous community engagement, as articulated by indigenous peoples and organisations. This brief may be of interest to health and development policymakers and practitioners working in indigenous communities and territories and can be read in conjunction with the SSHAP background report on ‘Indigenous Peoples and COVID-19.’

The COVID-19 pandemic has exposed long-standing social inequalities and vulnerabilities, with the most disadvantaged and marginalised groups bearing the greatest health, social, and economic burdens. Beyond documenting these vulnerabilities, there is a need to mitigate them and support the resilience of marginalised communities. ‘Community resilience’ can bolster community capacity to cope with the pressures of various shocks; this brief explores how its concepts can be applied to epidemics. It reviews the grey and academic literature on different approaches to community resilience. It covers 1) terminology, 2) lessons from practice, 3) the context of community resilience, 4) a systems approach, and 5) key human and social capacities. Social justice, inequality, equity, and fairness are highlighted as themes in need of further development for resilience as it relates to epidemic preparedness and response. This brief was developed for SSHAP by IDS (led by Megan Schmidt-Sane with Tabitha Hrynick) with Anthrologica (Eva Niederberger).

In July 2019, Ebola in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern and neighbouring countries were put on high alert. This paper examines the intersections of gender, caregiving, and livelihood practices in Uganda's border districts that emerged as key factors to consider in preparedness and response. This paper is based on an anthropological study of the Ebola context among Bantu cultures. We report on data from focus group discussions and key informant interviews with various sectors of the community. The study identified intersecting themes reported here: (1) women as primary caregivers in this context; and (2) women as providers, often in occupations that increase vulnerability to Ebola. Findings demonstrate the role that women play inside and outside the home as caregivers of the sick and during burials, and intersections with livelihood-seeking strategies. Because women's caregiving is largely unpaid, women face a double burden of work as they seek other livelihood strategies that sometimes increase vulnerability to Ebola. Epidemic response should address these intersections and the context-specific vulnerabilities of caregivers; it should also be localised and community-centred and able to attend to the cultural as well as the economic needs of a community.

في ضوء استمرار استشراء جائحة فيروس كورونا المستجد، ثمة حاجة إلى تقديم الدعم القوي للمجتمعات الأكثر تأثرا بالأزمات وتعزيز المرونة المجتمعية. نهج "المرونة المجتمعية" يعني الشراكة مع المجتمعات المحلية وتعزيز قدراتها بهدف التخفيف من تداعيات الجائحة، ومن ضمنها التداعيات الاجتماعية والاقتصادية. 1–3 لذا لا مجال للعودة إلى الوضع الذي كان سائداً قبل الجائحة، بل لا بد من إحداث تغيير جذري يتطرق لأوجه عدم المساواة ويعمل على تحسين الظروف الاجتماعية والاقتصادية. وفي حين أن النهج القائم على تعزيز قدرة المجتمع على الصمود لا يزال جديد نسبيًا فيما يتعلق بالتأهب لمواجهة الأوبئة والتصدي لها، فإنه يضع إطاراً للتعامل مع الصدمات الوبائية بطريقة شاملة ومن خلال إتباع نهج يشمل نظاما كاملا. 4–6 وبينما تركز الاستجابة للوباء والتصدي له على التخفيف من أوجه الضّعف، يمكن اللجوء إلى النهج القائم على تعزيز الصمود لبناء القدرات الحالية بهدف إدارة الآثار الصحية والاجتماعية والنفسية والاقتصادية الناتجة عن الوباء. وهذا يعزز من إضفاء الطابع المحلي على هذا النهج ومن قدرته على التكيف والاستدامة على المدى الطويل، ما يمثل المبادئ الأساسية للاستجابة للوباء وفقا للعلوم الاجتماعية. 7–9 يناقش هذا الموجز الاعتبارات المتعلقة بكيفية تقديم العاملين في القطاع الصحي والإنساني الدعم للمجتمعات من أجل الاستجابة والتعافي من فيروس كورونا المستجد باستخدام نهج المرونة المجتمعية. تم تطوير هذا الموجز لـصالح منصة العلوم الاجتماعية في العمل الإنساني من قبل معهد دراسات التنمية (تحت إشراف ميغان شميدت- ساين وتابيثا هرينيك بالتعاون مع أنثرولوجيكا (إيفا نايدربيرغر) وهو يقع ضمن مسؤولية منصة العلوم الاجتماعية في العمل الإنساني.

As the unequal impact of the COVID-19 pandemic continues, there is a need to robustly support vulnerable communities and bolster ‘community resilience.’ A community resilience approach means to work in partnership with communities and strengthen their capacities to mitigate the impact of the pandemic, including its social and economic fallout. However, this is not resilience which returns the status quo. This moment demands transformative change in which inequalities are tackled and socioeconomic conditions are improved. While a community resilience approach is relatively new to epidemic preparedness and response, it frames epidemic shocks more holistically and from the perspective of a whole system. While epidemic response often focuses on mitigating vulnerabilities, there is an opportunity to use a resilience framework to build existing capacities to manage health, social, psychosocial, and economic impacts of an epidemic. This makes a resilience approach more localised, adaptable, and sustainable in the long-term, which are key tenets of an epidemic response informed by social science. This brief presents considerations for how health and humanitarian practitioners can support communities to respond to and recover from COVID-19 using a community resilience approach. This brief was developed for SSHAP by IDS (led by Megan Schmidt-Sane with Tabitha Hrynick) with Anthrologica (Eva Niederberger).

أظهرت جائحة فيروس كورونا المستجد عدم المساواة وأوجه الضعف المترسخَين منذ فترة طويلة في المجتمع، حيث أن الفئات المجتمعية الأكثر حرمانًا وتهميشًا تتكبّد أثقل الأعباء الصحية والاجتماعية والاقتصادية1. لذا، والى جانب توثيق أوجه الضعف، هناك حاجة للتخفيف عن هذه الفئات المهمشة ودعم قدرتها على الصمود. يمكن أن تعزز " المرونة المجتمعية " قدرة المجتمع على التكيف مع الضغوط الناتجة عن الصدمات المختلفة. يبحث هذا الموجز كيفية تطبيق مفاهيم المرونة المجتمعية على الأوبئة ويستعرض المصادر الرمادية (المنشورات غير الرسمية) والأكاديمية حول المقاربات المختلفة للصمود المجتمعي. ويشمل ذلك 1) المصطلحات، 2) الدروس المستفادة من الممارسة، 3) سياق المرونة المجتمعية، 4) نهج النظم، 5) القدرات البشرية والاجتماعية الأساسية. يتم التطرق أيضًا إلى العدالة الاجتماعية وعدم المساواة والإنصاف والعدالة كمواضيع تحتاج إلى مزيد من التطوير للوصول إلى الصمود، باعتبارها ترتبط مباشرة بالتأهب للأوبئة والاستجابة لها. تم إعداد هذا الموجز لـصالح منصة العلوم الاجتماعية في العمل الإنساني \ معهد دراسات التنمية (تحت اشراف كل من ميغان شميدت-ساين وتابيثا هرينيك) بالتعاون مع أنثرولوجيكا (إيفا نايدربيرغر). هذا الموجز يقع ضمن مسؤولية منصة العلوم الاجتماعية في العمل الإنساني

The heterogeneous epidemiological picture for COVID-19 in Africa continues to generate debate. Modelling projections raise speculation about the phases and trends of SARS-CoV-2 outbreaks across the continent and how these differ from outbreaks elsewhere.[1–4][1] Continental efforts drew praise in

Research examining the sexual identities, behaviors, and experiences of bisexual men outside of Western contexts (including in India) is limited. Individuals who self-identify as bisexual due to their orientation toward partners of more than one gender face distinct psychosocial challenges relative to exclusively heterosexual, gay/lesbian, or other individuals. We conducted four focus group discussions (n = 22) and in-depth interviews (n = 50) with self-identified bisexual men (age 18 years and older) who were recruited from the metropolitan area of Mumbai, India, between June and August 2013. We triangulated and analyzed focus group and interview data using standard qualitative research techniques. Findings from our study suggest that multiple factors influence the sexual experiences of self-identified bisexual men in Mumbai, including contexts of sexual interactions, sexual positioning, and the gender of sexual partners. Participants described cultural meaning systems and psychosocial dynamics that regulate bisexual identity development, disclosure, and sexual decision making with male, female, and other partners. Secrecy, discretion, and sexual pleasure also influenced sexual behaviors and relationships. Although Western sexual identity categories are not necessarily equivalent in the Indian context, it is interesting and important to note that a number of individuals in India continue to use the identity label of "bisexual." Before developing interventions to meet unique sexual health needs of bisexual men, it is crucial to understand how these men perceive themselves, reconcile the ordinary aspects of their lives with their sexuality, and structure their relationships with partners.

Rationale Child maltreatment remains a serious but potentially preventable public health concern in the United States. Although research has examined factors associated with child maltreatment at the neighborhood level, few studies have explicitly focused on the role of the neighborhood built environment in maltreatment. Objective We begin to address these gaps by investigating caregivers' own perceptions of mechanisms by which neighborhood built environments may affect child maltreatment. Method Utilizing a grounded theory approach, we examined open-ended interview data from 400 adult residents residing in 20 different Cleveland, Ohio neighborhoods (census tracts) and caring for at least one child under 18 years of age. Results Our analysis revealed three primary pathways through which caregivers linked the neighborhood built environment to potential child maltreatment: housing density, physical neighborhood space as shaping family relations, and the internalization of the surrounding neighborhood-built environment. Conclusions Our findings suggest that aspects of the neighborhood built environment, such as the presence of abandoned houses or the lack of recreational centers, can be stressors themselves and may also critically alter families' thresholds for navigating other everyday pressures. Conversely, aspects of the neighborhood built environment, such as housing density, may work to mitigate the risk of maltreatment, either by promoting social support or by increasing the likelihood that maltreatment is reported to authorities. Additional research, both qualitative and quantitative, is integral to building and testing models of these separate but related pathways by which the neighborhood built environment may link to child maltreatment.

Objectives: Chronic kidney disease (CKD) is an emerging major public health concern in the United States. Shared decision-making (SDM) has gained attention as an important area of inquiry in chronic kidney disease research. Few studies focus on shared decision-making or preferences of older African Americans during the advanced stages of CKD before the initiation of dialysis. The objective of this study was to understand decision-making preferences and shared decision-making among older African Americans with advanced chronic kidney disease who have yet to start dialysis. Methods: Data were collected from an outpatient clinic sample of older African Americans ≥ 55 years old (N = 10) diagnosed with advanced CKD. Participants were administered a survey with open-ended questions related to shared decision-making, CKD healthcare and general healthcare preferences (both open-ended and closed-ended questions), and participant characteristics. A thematic analysis framework was applied to identify themes and patterns in the data. Results: Several themes emerged in regard to shared decision-making and patient preferences including: complexity of CKD management, uncertainty of prognosis, barriers and facilitators to CKD self-management and SDM, diagnosis and dialysis information, elements of SDM, and the structural and social context of SDM related to racial inequities. Discussion: Participants identified a nuanced understanding of the concerns related to managing CKD. The complex and ever-changing nature of CKD was emphasized as participants discussed how they perceived their care needs. This study provides implications for social work practice, healthcare policy and interprofessional collaboration in the care of older African Americans.

This article examines the social patterning of health, economic uncertainty, hegemonic masculinity, and vulnerability among men who live and work in a low-income sex work community in Kampala, Uganda. This problematises the notion that vulnerable communities are homogenous, in demographics, economic status, and risk. This article draws on ethnographic data collected in 2016, including semi-structured interviews and participant observation. This article uses a stratified risk framework to describe the central finding of this study, which is that men’s experience in Kataba is characterised by a struggle to fulfil the provider role that constitutes a core aspect of their socially ascribed gender role. In a context of economic scarcity, men’s lives are fraught with strain and this intersects with other forms of risk. Finally, by focusing on community vulnerability rather than individual risk, this work contributes to theories of gender and sex work, and informs HIV/AIDS praxis.