RESUMEN
Saskatoon has nearly half of the diagnoses of HIV in Saskatchewan, Canada, with an incidence rate among Indigenous populations within inner-city contexts that is 3 times higher than national rates. Previous research does not adequately explore the relations between HIV vulnerabilities within these contexts and the experiences of illness disclosure that are informed by identity transformations, experiences of stigma, and social support. From an intersectionality framework and a constructivist grounded theory approach, this research involved in-depth, semistructured interviews with 21 Indigenous people living with HIV and/or AIDS in Saskatoon, both male and female. In this article, we present the key themes that emerged from the interviews relating to experiences of HIV disclosure, including experiences of and barriers to the disclosure process. In the end, we highlight the important identity transformation and role of being and becoming a "helper" in the community and how it can be seen as a potential support for effective community health interventions.
Asunto(s)
Revelación , Infecciones por VIH/etnología , Estigma Social , Voluntarios/psicología , Síndrome de Inmunodeficiencia Adquirida/etnología , Femenino , Teoría Fundamentada , Humanos , Indígenas Norteamericanos , Entrevistas como Asunto , Masculino , Prejuicio , Saskatchewan , Medio Social , Apoyo SocialRESUMEN
BACKGROUND: A national baseline mapping of schistosomiasis and soil-transmitted helminthiasis (STH) was performed in Sierra Leone. The aim was to provide necessary tools for the Ministry of Health and Sanitation to plan the intervention strategies in the national integrated control program on neglected tropical diseases according to the World Health Organization (WHO) guidelines for preventative chemotherapy (PCT) and for future monitoring and evaluation. METHODOLOGY/PRINCIPAL FINDINGS: 53 primary schools were randomly selected through a two-staged random sampling throughout the country. Approximately one hundred children aged 5-16 years of age were systematically selected from each school and their stool samples examined in a field laboratory. A total of 5,651 samples were examined. Data were analyzed with multivariable logistic regression models using model-based geostatistics. Spatial analysis predicted that S. mansoni infection was positively associated with population density and elevation and that there was a large cluster of high risk of S. mansoni infection (prevalence >70%) in the north and most of the eastern areas of the country, in line with the observed prevalence in Kono (63.8-78.3%), Koinadugu (21.6-82.1%), Kailahun (43.5-52.6%), Kenema (6.1-68.9%) and Tonkolili (0-57.3%). Hookworm infection was negatively associated with population density and land surface temperature, and was high across Sierra Leone with a large cluster of high infection risk (prevalence >70%) in the north-eastern part of the country. Remarkably low prevalence of Ascaris lumbricoides (7.2%) and Trichuris trichiura (3.3%) was recorded when compared with results published in the 1990s. CONCLUSIONS/SIGNIFICANCE: Results justify PCT for schistosomiasis for school age children and at-risk adults every year in high-risk communities in five districts and every two years in moderate-risk communities in one more district. The high prevalence of STH, particularly hookworm, coupled with widespread anemia according to a national report in Sierra Leone, suggests all but one district justifying biannual PCT for STH for pre-school children, school age children, and at-risk adults. PCT for STH in the remaining district, Kono is justified annually.