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The British Association for Counselling and Psychotherapy (BACP) is the largest professional membership body within the field of counselling and psychological therapies in the UK, but there is a mismatch between its membership of >65,000 and its research impact. This article sets out a potential strategic direction as considered by an informal grouping of researchers and teachers in the field. Actionable research plans are outlined at three levels: client–practitioner, local communities, and societies. At the client–practitioner level, data‐informed practice can be readily implemented as a therapeutic aid akin to supervision, providing the potential for integrating research into everyday practice. At the community level, interdisciplinary collaborations together with a focus on equality, diversity, and inclusiveness are paths to building a community of researchers and citizens that includes marginalised populations. The importance of social justice extends to the societal level, connecting with politics at a micro and macro level, and engaging internationally to respond to actual threats (e.g., climate change). Across these three levels, high value is placed on data with its potential for informing and improving practice, but also enhancing the lives of people in communities and societies. Overall, research strategies need to be collaborative (i.e., collegial) and less singular (i.e., individually project‐based), developing cumulative knowledge around specific topics via a 'capture and build' strategy for small projects with strategic oversight by BACP. Clarity of research strategy combined with collaborative and collective action from BACP and leaders in the field can help realise the full potential of BACP's research capacity. [ABSTRACT FROM AUTHOR]

Abstract Background Process evaluations are increasingly integrated into randomised controlled trials (RCTs) of complex interventions to document their delivery and interactions with local systems and dynamics, helping understand observed health outcomes. Yet process evaluations often struggle to assess relevant contextual determinants, leaving much of the important role of “context” in shaping an intervention’s mechanisms opaque in many studies. A lack of easily adapted data collection methods to help define and operationalise indicators of context likely contributes to this. Methods We present a method to help structure measures of context in process evaluations and describe its use in two very different settings. The “Context Tracker” is an innovative tool for use within trials and quasi-experiments to more systematically capture and understand key dimensions of context. It was developed in Zimbabwe as part of a cluster randomised controlled trial and then adapted for a quasi-experimental evaluation in the UK. Both studies provided harm reduction and health services for marginalised and hard-to-reach populations. Results We developed the Context Tracker to be both standardised (i.e. formatted and applied in the same way across study sites) and flexible enough to allow unique features to be explored in greater detail. Drawing on the Context and Implementation of Complex Interventions (CICI) and Risk Environments frameworks, we mapped 5 domains across micro, meso and macro levels in a simple table and used existing evidence and experience to predict factors likely to affect delivery of and participation in intervention components. We tracked these over time across study sites using routine programme statistics, observation and qualitative methods. The Context Tracker enables identification and comparison of facilitators and barriers to implementation, variations in engagement with interventions, and how mechanisms of action are (or are not) triggered in different settings. Conclusions The Context Tracker is one example of how evidence-based contextual determinants can be used to guide data collection and analysis within process evaluations. It is relevant in low- and high-income settings and applicable to both qualitative and quantitative analyses. While perhaps most useful to process evaluations of complex interventions targeting marginalised communities, the broader approach would benefit a more general research audience.

Background: Process evaluations are increasingly integrated into randomised controlled trials (RCTs) of complex interventions to document their delivery and interactions with local systems and dynamics, helping understand observed health outcomes. Yet process evaluations often struggle to assess relevant contextual determinants, leaving much of the important role of "context" in shaping an intervention's mechanisms opaque in many studies. A lack of easily adapted data collection methods to help define and operationalise indicators of context likely contributes to this. Methods: We present a method to help structure measures of context in process evaluations and describe its use in two very different settings. The "Context Tracker" is an innovative tool for use within trials and quasi-experiments to more systematically capture and understand key dimensions of context. It was developed in Zimbabwe as part of a cluster randomised controlled trial and then adapted for a quasi-experimental evaluation in the UK. Both studies provided harm reduction and health services for marginalised and hard-to-reach populations. Results: We developed the Context Tracker to be both standardised (i.e. formatted and applied in the same way across study sites) and flexible enough to allow unique features to be explored in greater detail. Drawing on the Context and Implementation of Complex Interventions (CICI) and Risk Environments frameworks, we mapped 5 domains across micro, meso and macro levels in a simple table and used existing evidence and experience to predict factors likely to affect delivery of and participation in intervention components. We tracked these over time across study sites using routine programme statistics, observation and qualitative methods. The Context Tracker enables identification and comparison of facilitators and barriers to implementation, variations in engagement with interventions, and how mechanisms of action are (or are not) triggered in different settings. Conclusions: The Context Tracker is one example of how evidence-based contextual determinants can be used to guide data collection and analysis within process evaluations. It is relevant in low- and high-income settings and applicable to both qualitative and quantitative analyses. While perhaps most useful to process evaluations of complex interventions targeting marginalised communities, the broader approach would benefit a more general research audience. [ABSTRACT FROM AUTHOR]

As health data infrastructure improves, we have the opportunity to link increasing volumes of data in order to investigate important health problems. This is perhaps most pertinent when looking at the experiences and outcomes of our most disadvantaged groups, who are often invisible in data obtained through primary research. Whilst these data offer enormous opportunity, there are also ethical implications in their use, which are less frequently discussed than in relation to their qualitative counterparts. As a diverse group of clinicians and academics working across public health, we share our experience and understanding of how we can improve our reflexivity in health data science and ensure that research in this area is ethically conducted in co-production with the people whose data we are using. We discuss the potential opportunities, challenges and impacts of using administrative data to investigate marginalised populations. [ABSTRACT FROM AUTHOR]

Considering the persistence of significant health inequities in India, exploring the interface between health equity and social work education is a critical research priority. This article attempts to present a systematic analysis of the present status of health equity and social work training in India, elaborating on healthcare discrepancies among various populations in India, examining reasons for elevated morbidity and mortality rates among marginalized communities, and approaches to social work education at present. Consequently, curriculum revision should be all-inclusive and focus on highlighting fairness in health provision as well as cultural competency with an emphasis on social justice. It also calls for a paradigm shift towards contextualized knowledge, critical pedagogy and community engagement to prioritize health equity by suggesting that future training should focus on a holistic approach to dealing with preventable illnesses emanating from these determinants. In conclusion, this article points out the significance of giving more attention towards health equity within Indian schools of social work while providing some directions for possible research lines.

Abstract Objective: Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. Design: We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0–36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0–27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. Setting: Northern Kenya, June–July 2019. Participants: Daasanach pastoralist households (n 136) from seven communities. Results: In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. Conclusions: These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access.

The use of administrative health data for research, monitoring, and quality improvement has proliferated in recent decades, leading to improvements in health across many disease areas and across the life course. However, not all populations are equally visible in administrative health data, and those that are less visible may be excluded from the benefits of associated research. Socially excluded populations -- including the homeless, people with substance dependence, people involved in sex work, migrants or asylum seekers, and people with a history of incarceration -- are typically characterised by health inequity. Yet people who experience social exclusion are often invisible within routinely collected administrative health data because information on their markers of social exclusion are not routinely recorded by healthcare providers. These circumstances make it difficult to understand the often complex health needs of socially excluded populations, evaluate and improve the quality of health services that they interact with, provide more accessible and appropriate health services, and develop effective and integrated responses to reduce health inequity. In this commentary we discuss how linking data from multiple sectors with administrative health data, often called cross-sectoral data linkage, is a key method for systematically identifying socially excluded populations in administrative health data and addressing other issues related to data quality and representativeness. We discuss how cross-sectoral data linkage can improve the representation of socially excluded populations in research, monitoring, and quality improvement initiatives, which can in turn inform coordinated responses across multiple sectors of service delivery. Finally, we articulate key challenges and potential solutions for advancing the use of cross-sectoral data linkage to improve the health of socially excluded populations, using international examples.

Objective: Water plays a critical role in the production of food and preparation of nutritious meals, yet few studies have examined the relationship between water and food insecurity. The primary objective of this study, therefore, was to examine how experiences of household water insecurity (HWI) relate to experiences of household food insecurity (HFI) among a pastoralist population living in an arid, water-stressed region of northern Kenya. Design: We implemented the twelve-item Household Water Insecurity Experiences (HWISE, range 0–36) Scale and the nine-item Household Food Insecurity Access Scale (HFIAS, range 0–27) in a cross-sectional survey to measure HWI and HFI, respectively. Data on socio-demographic characteristics and intake of meat and dairy in the prior week were collected as covariates of interest. Setting: Northern Kenya, June–July 2019. Participants: Daasanach pastoralist households (n 136) from seven communities. Results: In the prior 4 weeks, 93·4 % and 98·5 % of households had experienced moderate-to-severe HWI and HFI, respectively. Multiple linear regression analyses indicated a strong association between HWI and HFI. Each point higher HWISE score was associated with a 0·44-point (95 % CI: 0·22, 0·66, P = 0·003) higher HFIAS score adjusting for socio-economic status and other covariates. Conclusions: These findings demonstrate high prevalence and co-occurrence of HWI and HFI among Daasanach pastoralists in northern Kenya. This study highlights the need to address HWI and HFI simultaneously when developing policies and interventions to improve the nutritional well-being of populations whose subsistence is closely tied to water availability and access. [ABSTRACT FROM AUTHOR]

Chronic pain management among marginalised populations have been extensively researched in North America, particularly amidst the opioid crisis. But little published research exists on this subject from Africa. This study explored experiences and management of chronic pain among marginalised women in the context of regulation of opioid prescribing using data from 16 qualitative interviews with women who use drugs (WWUD) in Uyo, Nigeria. Chronic pain was exacerbated by structural and everyday violence that acted to marginalise women and create a context of risk for inadequately managed pain. Participants experienced difficulty accessing biomedical pain management due to structural and systemic barriers, including cost, restrictions on opioid prescribing, stigma and other discriminatory practices, communication barriers and lack of social support. Restrictions on opioid prescribing and systemic discriminations against marginalised WWUD encouraged reliance on informal sources for falsified and substandard medications for pain treatment, which increased the risk of harm. Findings highlight a need for multi-component responses that address structural and systemic barriers to pain management, including improving access to opioid medications. [ABSTRACT FROM AUTHOR]

Stigma in health services undermines diagnosis, treatment and successful health outcomes for all communities, but especially for those affected by blood‐borne viruses and sexually transmitted infections (STIs). This study sought to examine experiences in accessing and receiving health services, including what characteristics promoted better health, safety and well‐being for people with blood‐borne viruses or STIss. It conducted 46 in‐depth interviews with people who inject drugs, gay men and other men who have sex with men, sex workers, people in custodial settings, culturally and linguistically diverse people, Indigenous Australians and young people in one Australian urban community setting. Findings reveal that stigma persists in the provision of healthcare services, and that previous experiences of discrimination or fear of mistreatment may result in a reluctance to continue to access services. On‐going staff training and education are important to ensure healthcare environments are welcoming and inclusive. Specialised services and services that employed peers were seen as favourable. Attending different services for different health needs created particular access challenges and undermined participant ability to engage in more holistic healthcare. The fragmented structure of health services was thus seen as a barrier to accessing health services, and stronger collaboration between health services is recommended. [ABSTRACT FROM AUTHOR]

Loneliness research has tended to focus on mainstream and older populations despite evidence that non‐mainstream groups, like those experiencing homelessness, may experience loneliness differently. Limited existing research indicates that (a) people who have been homeless experience loneliness as multidimensional (as a pluralistic, non‐unidimensional emotion, experienced specific to lacked relationships) and (b) mainstream loneliness scales may be inappropriate for this group. The current study piloted and appraised the feasibility the short version of the Social and Emotional Loneliness Scale for Adults (SELSA‐S) among 129 Australian adults with a lived experience of homelessness. Exploratory Factor Analysis and an observational questionnaire appraisal were used to assess factorial and content validity and showed the measure did not fit this sample as well as in mainstream samples. Removal of items that participants found difficult to comprehend/answer improved the factorial fit of the scale. In conclusion, the SELSA‐S may be inappropriate for measuring loneliness among people who have experienced homelessness. Further research needs to explore the potentially different structure of loneliness among marginalised groups so that a better understanding of loneliness can be reached. [ABSTRACT FROM AUTHOR]

Guided by the Intersectionality Framework, we examined the differential in breast cancer care experience across population subgroups in England. Secondary data analysis using the 2017/2018 National Cancer Patient Experience Surveys. We used disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with social position. We then used logistic regression to investigate the odds (Odds Ratio (OR), 95% confidence intervals) of reporting positive care experience adjusting for patient, clinical, and Trust level factors. Poorer care experience was predominantly reported by the most deprived younger and minoritised ethnic groups. Statistically significant findings were observed in adjusted multivariable analyses. Compared to patients aged 65–74 years, younger respondents were less likely to rate their care favourably (16–34 years old OR adj. = 0.55 (0.36–0.84). Compared to White British, Asian (OR adj. = 0.51 (0.39–0.66)) and Black African women (OR adj. = 0.53 (0.33–0.88)) were less likely to rate their care favourably. The least affluent respondents were less likely to rate their care favourably (OR adj. = 0.79 (0.64–0.97)). There is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity, and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalisation to inform improvement initiatives targeting patients at higher risk of vulnerability. • Intersectionality is a useful tool to build more precise maps of cancer inequities. • Multifaceted forms of marginalisation exacerbate cancer inequities for minoritised patients. • Intersectional inequities in care experience exist among women with breast cancer. • Intersectional-informed policies and services are key to tackle cancer inequities. [ABSTRACT FROM AUTHOR]

In the Soviet period, the incidence of venereal diseases (VDs)2 was ideologically interpreted by authorities as a deficiency inherent in capi- talist countries. It was stated that VDs would be eliminated in the Soviet Union at the earliest possible date. Compared to the independent Republic of Latvia (1918–1940), during the Soviet period, despite a larger popu- lation, the number of registered VDs infected patients was significantly lower. In such a historical context, a strange ideological obsession could be observed in the activities pursued by Soviet authorities when fighting VDs. The notion of the VDs as a remnant of the capitalist system determined the treatment of Soviet citizens infected by the VDs as marginalised populations. In order to achieve the goal of becoming a country where the VDs were eliminated, the Soviet Union practised a drastic dispensarisation system in the treatment of VDs, which was focused only on certain groups of the population that were identified in the documents of internal use for the fight against VDs. Starting with the 1960s, the VDs fighting policy also included the fight against prostitution, euphemised as the fight against “frivolous women”, by directing the control against the female gender. At the same time, the decisions at the highest level of the Soviet government, that were mostly marked by the “not to be published” stamp, formally corresponded to the ideas of gender equality and Soviet ideas of rule of law. In the context of the marginalised populations, authorities were of the opinion that it was justifiable to humiliate citizens, who would be forced to undergo unjustified medical examination, because the smallest proportion of marginalised populations, who were subjected to forced medical examination, turned out to be VDs positive. When assessing the extension of such prac- tices to the wider population, it was recognised that this would not contrib- ute to the strengthening of the Soviet rule of law. The purpose of the article is to reveal the development of the population categorisation practice in the context of the VDs fighting policy in the Latvian SSR.

We introduce and reflect on the benefits of a game developed from a qualitative study of general practice reception processes undertaken in two New Zealand (NZ) cities. In this research, we elicited the views of receptionists, practice managers, and individuals marginalised by health care processes (‘patients’). Data collection followed an iterative process, beginning with receptionists, then ‘patients’, then managers, and returning to receptionists. Consistent with best-practice research in NZ, Māori were involved in all phases of the field research in multiple roles: as advisors, researchers, and participants. The study was informed by critical theory and employed thematic analysis. We describe how we translated the findings into a format accessible for health care teams through the creation a board game. This game, modelled on the children's game ‘Snakes and Ladders’, exposes the ‘rules’ of general practice engagement when players adopt the roles of typical patient identities encountered in the study and try to ‘achieve’ a clinical appointment. Feedback received while workshopping the game highlights how games can facilitate unprecedented discussions across the table between receptionists, managers and clinicians. We conclude that in playing an actual game as a research output, members of primary care teams are able to see the ‘journey to a clinical appointment’ in a new light. Playing the game offers an activity that is paradoxically both enjoyable and unsettling in exposing how general practice reception processes advantage the most privileged individuals while disadvantaging individuals who experience broader social exclusion.

Abstract Background In Botswana, one fifth of the adult population is infected with HIV, with young women most at risk. Structural factors such as poverty, poor education, strong gender inequalities and gender violence render many young women unable to act on choices to protect themselves from HIV. A national trial is testing an intervention to assist young women to access government programs for returning to education, and improving livelihoods. Accessing marginalised young women (aged 16–29 and not in education, employment or training) through door-to-door recruitment has proved inefficient. We investigated social networks of young women to see if an approach based on an understanding of these networks could help with recruitment. Methods This mixed methods study used social network analysis to identify key young women in four communities (using in-degree centrality), and to describe the types of people that marginalised young women (n = 307) turn to for support (using descriptive statistics and then generalized linear mixed models to examine the support networks of sub-groups of participants). In discussion groups (n = 46 participants), the same young women helped explain results from the network analysis. We also tracked the recruitment method for each participant (door to door, peers, or key community informants). Results Although we were not able to identify characteristics of the most central young women in networks, we found that marginalised young women went most often to other women, usually in the same community, and with children, especially if they had children themselves. Rural women were better connected with each other than women in urban areas, though there were isolated young women in all communities. Peer recruitment contributed most in rural areas; door-to-door recruitment contributed most in urban areas. Conclusions Since marginalised young women seek support from others like themselves, outreach programs could use networks of women to identify and engage those who most need help from government structural support programs. Methods that rely on social networks alone may be insufficient, and so a combination of approaches, including, for instance, peers, door-to-door recruitment, and key community informants, should be explored as a strategy for reaching marginalised young women for supportive interventions.

Rickettsioses are a group of tick-borne infectious diseases. The clinical presentation is characterised by unspecified manifestations seen in illnesses such as dengue, zika, and chikungunya, so identification is complicated. The greatest impact occurs among the world's poorest populations. Rickettsioses have hardly been studied from a qualitative perspective to show the cultural horizon of the people affected. We aimed to describe the perception of Mayan indigenous farmers about their risk perception for disease transmission. We used the ethnographic method and built life stories. From the perspective of people interviewed, their relationship with the reservoirs for vectors did not represent a high risk, did not consider that blisters and other skin lesions are caused by tick bites. Contributions as this article show the thinking logic underlying the perception of risk of these impoverished populations. To produce synergy with prevention efforts, it is necessary to know the cultural perspectives of targeted groups. [ABSTRACT FROM AUTHOR]

Concepts related to positive health in later life are increasingly prevalent within community‐based health and social care policy. With a greater emphasis on inclusion health for older populations, there is a critical need to understand the determinants of such states for those most at risk of societal disadvantage. Focusing on two such groups, the aim of this article is to synthesise international research on the life‐course and structural determinants of positive subjective health for older homeless people and older Irish Travellers. Two scoping reviews were conducted (one for each group) to capture state‐of‐the art knowledge published from 1998 to 2020. The reviews were completed from July to December 2018, and repeated from March to April 2020. Thirty‐eight publications were included in the final sample (older Travellers: 10 sources; older homeless: 28 sources). Specific life‐course and structural factors were evident for both groups, as well as commonalities with respect to: accumulated exclusions; complexity of needs; accommodation adequacy/stability and independence and resilience. Research gaps are identified concerning: lack of conceptualisation of positive health; the application of life‐course perspectives and the absence of an environmental gerontological analysis of the situations of both groups. [ABSTRACT FROM AUTHOR]

This article describes a two-phased reflexive ethical process initiated when choosing digital cameras for the photovoice method in research with men living in low-income contexts. While this participatory method aims to flatten power asymmetries in researcher–researched relationships, debate is needed about how pragmatic technology choices may inadvertently underscore or even reinforce participants' situated experiences of disempowerment and constraint. Critically engaging with an ethics of care approach to decision-making, we unpick what superficially appears to be a straightforward problem of method and demonstrate how pragmatic decisions may confound researchers' efforts towards democratisation in research. We reflect on how such efforts may inadvertently obscure contextual processes shaping the potential for participants to engage in research. Our reflections demonstrate the need to take seriously all decision-making throughout the research process as integral to a wider politics of method and ethics. [ABSTRACT FROM AUTHOR]

Health-care providers are powerful figures in society. An informed service user may be able to identify regulatory non-compliance and abuses by these actors, but reporting them is not a mere administrative procedure. It is an act that stirs existing power relations and social hierarchies. This article argues that the essence of an accountability intervention is the process through which service users collect and analyse evidence that is then used to confront power at different governance levels. The response from authorities is assessed and strategies adjusted accordingly in adaptive cycles of accountability action. Based on ten years' experience supporting indigenous citizen-led accountability action in Guatemala, the authors describe how their approach evolved from an emphasis on technical components to a politically informed approach with interdisciplinary collaboration and explicit engagement with power. This article summarises lessons learned and their relevance for organisations working in health accountability in highly unequal settings. [ABSTRACT FROM AUTHOR]

This paper reports on key findings of a critical qualitative inquiry undertaken with an Indigenous early child development (ECD) program in Canada, known as the Aboriginal Infant Development Program (AIDP). In depth, semi-structured interviews were used to obtain the perspectives of: Indigenous caregivers and Elders, AIDP workers, and administrative leaders. The findings centre on: (1) a relational perspective of family wellbeing that emphasises the inseparability between child health inequities and the impact of structural social factors on families’ lives, and (2) how AIDP workers’ enact relational accountability to families by: (a) fostering cultural connections; (b) creating networks of belonging and support; (c) responding to caregivers’ self-identified priorities; (d) mitigating racism in healthcare encounters, and (e) deferring an ‘ECD agenda’. Rather than a one-size-fits-all model, these findings illustrate relational approaches to early intervention, characterised by a broader and socially responsive scope of practice and the deferral of a normative ‘ECD agenda’. This study has relevance in a variety of international contexts and to a broad range of disciplines and programs that serve families and children impacted by structural inequities. [ABSTRACT FROM AUTHOR]

The article analyses market-oriented social enterprises from a social welfare perspective, within the context of the innate conflict between business and welfare orientations. After defining the concept of market-oriented social enterprises and presenting some successful examples on such entities that employ different marginalised populations, particularly people with disabilities, the article asks three interrelated questions: (i) What policy environment is needed to encourage the development of social enterprises? (ii) Given the innate tension between the social and economic objectives in social enterprises, what structural principles are needed to enable them to meet those dual objectives? Lastly, (iii) What intervention modalities are best suited to help individual participants in those frameworks? Answers to these questions are discussed within conceptual frameworks from the worlds of welfare and business that jointly provide a base for a social welfare rationale for market-oriented social enterprises. [ABSTRACT FROM AUTHOR]

Surrogate alcohol, i.e. alcohol not intended or not officially intended for human consumption, continues to play an important role in alcohol consumption in Russia, especially for people with alcohol dependence. Among the different types of surrogate alcohol, there are windshield washer antifreeze liquids; these products are the cheapest kinds of non-beverage alcohol available and thus likely to be used by the most deprived and marginalised groups such as homeless people with alcohol dependence. Although it is well known, that non-beverage alcohol is used for consumption by various groups in Russia, and although there are laws to prohibit the use of methanol as part of windshield washer antifreeze liquids for the very reason that such products could be used as surrogate alcohol, we detected products in retail sale which were a mix of water and methanol only. Methanol poses serious health threats including blindness and death, and there had been repeated methanol deaths from surrogate alcohol in Russia over the last years. If law-enforcement does not change for surrogate products, we can expect more methanol-resulting deaths in the most deprived and marginalized groups of people with alcohol dependence in Russia. In addition, ingredients with questionable safety profiles such as formic acid should also be prohibited in non-beverage alcohol products that are likely to be consumed as surrogate alcohol. [ABSTRACT FROM AUTHOR]

Background: Although health is a right of all individuals without any distinction, the realisation of this right has remained very difficult for the marginalised populations of poor countries. Inequitable distribution of health opportunities globally is a major factor in explaining why this is the case. Whereas the Protection, Promotion and Fulfilment of the health rights of poor country citizens are a joint responsibility of both domestic and external governments, most governments flout their obligations. So far disproportionate effort has been dedicated to reaffirming and interpreting these obligations as opposed to investigating the fundamental question regarding why these obligations have nevertheless remained largely unfulfilled. Further the normative question regarding what ought to be done about the shortcomings of current obligations has been largely ignored. Methods: We conduct a critical content analysis of existing literature on efforts towards the realisation of the health rights of marginalised populations in our attempt to ascertain their capacity to guarantee basic health opportunities to marginalised populations. In our analysis we treat issues of 'health rights' and 'justice in global health' as having unity of purpose -- guaranteeing basic health opportunities to the marginalised populations. Results: We identify two sets of reasons for the failure of present obligations for global distributive justice in general: a set of 'superficial reasons' and a set of 'fundamental reasons' which account for the superficial reasons. Discussion: In order to overcome these reasons we propose a strategy which consists in specifying a number of minimum and less-demanding obligations for both external and domestic governments to guarantee to all individuals a certain threshold of health goods and services. We argue that these minimum obligations can be freely accepted and fully complied with or enforced with "a thin system of enforcement" without significant threat to national sovereignty and autonomy. Conclusion: The futility of countries' obligations for the health rights of the global poor as is the case with global distributive injustice is because of lack of political will to specify and enforce such obligations. Minimum obligations should be specified and enforced with a "thin system" which is consistent with principles of national sovereignty and autonomy. [ABSTRACT FROM AUTHOR]

In India, increasing uptake of voluntary HIV testing among ‘core risk groups’ is a national public health priority. While HIV testing uptake has been studied among key populations in India, limited information is available on multi-level barriers and facilitators to HIV testing, and experiences with free, publicly available testing services, among key populations. We conducted 12 focus groups (n = 84) and 12 key informant interviews to explore these topics among men who have sex with men, transgender women, cisgender female sex workers, and injecting drug users in the city of Chennai. We identified inter-related barriers at social-structural, health-care system, interpersonal, and individual levels. Barriers included HIV stigma, marginalised-group stigma, discrimination in health-care settings, including government testing centres, and fears of adverse social consequences of testing HIV positive. Facilitators included outreach programmes operated by community-based/non-governmental organisations, accurate HIV knowledge and risk perception for HIV, and access to drug dependence treatment for injecting drug users. Promoting HIV testing among these key populations requires interventions at several levels: reducing HIV-related and marginalised-group stigma, addressing the fears of consequences of testing, promoting pro-testing peer and social norms, providing options for rapid and non-blood-based HIV tests, and ensuring non-judgmental and culturally competent HIV counselling and testing services. [ABSTRACT FROM PUBLISHER]

Background: Self-identified lesbian and bisexual African-American women living in the southern United States are a relatively hidden subpopulation within the lesbian, gay, bisexual and transgender (LGBT) community. Existing research suggests that African-American lesbian and bisexual women are at high risk for sexually transmissible infections (STIs), but the sexual and reproductive health needs of this population are just beginning to be understood. Methods: We conducted four focus groups and five individual interviews with 24 lesbian and bisexual African-American women living in the Jackson, Mississippi, metropolitan area, recruited through the local STI clinic and through word of mouth. We aimed to characterise the role of two types of social organisations (lesbian families and noncollegiate lesbian sororities and fraternities) among the local LGBT community, and their influence on the sexual health of their members. Results: Both types of social organisations serve positive functions for their members. Lesbian families provide support and stability; this appears beneficial for younger individuals, who may lack support from biological families. Lesbian sororities and fraternities are visible due to their emphasis on community service, and offer a strong sense of solidarity and belonging. In both organisation types, discussions about sex were common, although members acknowledged a lack of information regarding safer sex among lesbian and bisexual women. Conclusions: Existing social organisations within the LGBT community, such as lesbian families and lesbian sororities and fraternities, should be incorporated into community-based popular opinion leader or lay heath advisor interventions in an effort to meet the sexual and reproductive health needs of marginalised populations. [ABSTRACT FROM AUTHOR]

Introduction and Aims. In an era of health care rationalisation, residential detoxification services catering for drug- and alcohol-dependent homeless people are being closed. The principal findings of a recent evaluation of a non-medicated residential detoxification service are presented. The aims were to describe the characteristics of residents, their experience of admission, rates of withdrawal completion, referral patterns, staff and key informant perceptions of the service and its role within the wider treatment system. Design and Methods. A process evaluation was utilised incorporating interviews with residents (n = 80) and key informants (n = 13); a survey of all service staff (n = 10); and demographic and clinical data for all residents (n = 392) admitted over one calendar year. Results. Residents were heavily substance-dependent and marginalised, with many exhibiting substantial mental and physical health impairments. Polydrug use and frequent prior engagement with drug and alcohol services were common. The majority completed withdrawal and were referred to further treatment. Residents who presented for heroin and other opiate withdrawal were more likely than other residents to leave before completing treatment (odds ratio 2.47, 95% confidence interval 1.48 - 4.15). Information from key informants, service staff and residents converged in underscoring the important role performed by the service. Discussion and Conclusion. Out-patient detoxification for homeless and severely drug- and alcohol-dependent populations is unrealistic. For this group, access to residential detoxification is vital as it provides an environment where potentially serious medical and psychological complications can be managed. There continues to be a clear role for supervised withdrawal in such a setting. [Silins E, Sannibale C, Larney S, Wodak A, Mattick R. Residential detoxification: Essential for marginalised, severely alcohol- and drug-dependent individuals. Drug Alcohol Rev 2008;27:414-419] [ABSTRACT FROM AUTHOR]

This paper considers an under-examined space in primary health care - the reception area/waiting room. This space can be challenging to negotiate, particularly for those who experience social marginalisation. We begin by situating the significance of the 'entry into the health care setting' in the patient journey in terms of time as well as space. Through an analysis of interview and focus group data gathered in a New Zealand study, we highlight ways that patients view these spaces as firmly bounded and confronting. In reflecting on the data, we then identify the potential for these spaces to be more permeable. We conclude that this spatio-temporal context need not be one of constraint. Rather, there are ways in which the boundaries of this space can be potentially enabling to those required to pause in the process of enacting patienthood. [ABSTRACT FROM AUTHOR]

Background: Respondent-driven sampling (RDS) is an increasingly popular method of recruiting participants from hard-to-reach populations and has traditionally been used to estimate the prevalence of HIV among marginalized people. The STROBE-RDS guidelines were published in 2015 to improve the reporting of these studies. We aim to determine the current applications of RDS and the quality of reporting of these studies., Methods: The SCOPUS, PubMed, and CINAHL databases were used to find papers published in 2017, relating to RDS. Papers meeting the inclusion criteria of cross-sectional studies using RDS were classified according to the study outcome and target population. A random sample of 25 papers was selected to evaluate the quality of reporting using the STROBE-RDS guidelines., Results: Men who have sex with men, people who inject drugs, and female sex workers were the most common populations for RDS studies; over half of the studies examined the HIV epidemic. Quality of reporting is good with respect to the original STROBE guidelines but is generally weaker with respect to RDS-specific aspects of the study, including recruitment and statistical analysis., Conclusion: Most authors are using RDS appropriately and aware of the need for statistical adjustments to RDS data. Nonetheless, the STROBE-RDS guidelines should be more widely disseminated to promote better reporting of key aspects of RDS studies., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: In Botswana, one fifth of the adult population is infected with HIV, with young women most at risk. Structural factors such as poverty, poor education, strong gender inequalities and gender violence render many young women unable to act on choices to protect themselves from HIV. A national trial is testing an intervention to assist young women to access government programs for returning to education, and improving livelihoods. Accessing marginalised young women (aged 16–29 and not in education, employment or training) through door-to-door recruitment has proved inefficient. We investigated social networks of young women to see if an approach based on an understanding of these networks could help with recruitment. Methods: This mixed methods study used social network analysis to identify key young women in four communities (using in-degree centrality), and to describe the types of people that marginalised young women (n = 307) turn to for support (using descriptive statistics and then generalized linear mixed models to examine the support networks of sub-groups of participants). In discussion groups (n = 46 participants), the same young women helped explain results from the network analysis. We also tracked the recruitment method for each participant (door to door, peers, or key community informants). Results: Although we were not able to identify characteristics of the most central young women in networks, we found that marginalised young women went most often to other women, usually in the same community, and with children, especially if they had children themselves. Rural women were better connected with each other than women in urban areas, though there were isolated young women in all communities. Peer recruitment contributed most in rural areas; door-to-door recruitment contributed most in urban areas. Conclusions: Since marginalised young women seek support from others like themselves, outreach programs could use networks of women to identify and engage those who most need help from government structural support programs. Methods that rely on social networks alone may be insufficient, and so a combination of approaches, including, for instance, peers, door-to-door recruitment, and key community informants, should be explored as a strategy for reaching marginalised young women for supportive interventions. [ABSTRACT FROM AUTHOR]