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PubMed2004

Sexual patterning and condom use among a group of HIV vulnerable men in Thika, Kenya.

BACKGROUND/AIM: A composite sample of 37 peer educators and 215 members of self help groups of male informal sector workers in Thika, Kenya, targeting HIV/AIDS prevention, were interviewed about their sexual behaviour, using a customised template, as part of a broader survey on gender attitudes and peer pressure. METHOD: Details on each sexual partner reported by each man over a 12 month recall period included type of partner, months during which sexual relations took place, and condom use. RESULTS: The men reported 471 sexual partners over the recall period, with a range of 0-16 partners, and an average of just under two partners. 8% of men had had no sexual partner, half were monogamous, and 3% had multiple partners with whom they used condoms exclusively, leaving 39% at varying degrees of risk. Condom use increased significantly with reduced intimacy of partner. 16% of men reported having at least one liaison with a female sex worker and two thirds of such liaisons were exclusively protected by condom use. Younger, single men had significantly more partners, but were more likely to use condoms. Duration of membership in self help groups was strongly associated with exclusive use of condoms with casual or FSW partners. Recorded attitudes corresponded somewhat with practice, but the data showed large gaps between the two, and low levels of gender sensitivity. CONCLUSION: There is some evidence that group membership has resulted in increased condom use and partner reduction, but there are doubts as to the extent to which the "ABC" strategy can be successful in stemming the HIV/AIDS epidemic. It may be necessary for interventions to target contextual issues, particularly gender relations, if the approach is to be more successful.

Adult↗
PubMed1995

Older women's health: 'taking the pulse' reveals gender gap in medical care.

In the United States, for every 100 men age 65 and older, there are 147 women, a ratio that has social and medical consequences. Five panelists "take the pulse" of older women's health in general and in the offices of primary care physicians in particular. They assess the status of medical education and the need to include older women in research and drug trials, issues of gender bias in health insurance and quality of treatment, ways to improve the use of preventive health services--such as mammography and Pap smears--by older women, and the role of office physicians in identifying and helping victims of domestic violence.

Aged↗
PubMed2004

Challenging gender stereotypes in the counselling of adult survivors of childhood sexual abuse.

When working with adult survivors of childhood sexual abuse, the pairing of client with practitioner has implications for both parties. Many therapeutic pairings are ad hoc or based on stereotypical assumptions made by referrers or practitioners themselves. This paper reports on a small-scale study of practitioners working in the mental health directorate of an NHS Trust in Wales. One aim of the study was to explore practitioners' views on appropriate therapeutic pairings. Fifty-three respondents completed a postal questionnaire and six face-to-face interviews were also conducted. Key themes emerged from the study. These were social and cultural stereotyping, gender specific issues, the therapeutic relationship, service and professional issues and special opinions and unique angles. The terms 'therapist' and 'practitioner' will be used interchangeably in this paper.

Adult↗
PubMed2006

Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease.

Coronary heart disease is the leading cause of death and disability in the U.S., but recent advances have not led to declines in case fatality rates for women. The current review highlights gender-specific issues in ischemic heart disease (IHD) presentation, evaluation, and outcomes with a special focus on the results derived from the National Institutes of Health-National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. In the second part of this review, we will assess new evidence on gender-based differences in vascular wall or metabolic alterations, atherosclerotic plaque deposition, and functional expression on worsening outcomes of women. Additionally, innovative cardiovascular imaging techniques will be discussed. Finally, we identify critical areas of further inquiry needed to advance this new gender-specific IHD understanding into improved outcomes for women.

Atherosclerosis↗
PubMed2002

Gender imbalance in living organ donation.

Living organ donation has developed into an important therapeutic option in transplantation medicine. However, there are some medico-ethical problems that come along with the increasing reliance on this organ source. One of these concerns is based on the observation that many more women than men function as living organ donors. Whereas discrimination and differential access have been extensively discussed in the context of cadaveric transplantation and other areas of health care, the issue of gender imbalance in living organ donation has received less attention. This paper presents relevant data from the Eurotransplant and UNOS transplantation systems (1) and discusses possible explanations for the documented gender discrepancies. The conclusion calls for a review of existing practice guidelines in order to secure effective protection of particularly vulnerable potential donors and an equitable donor-recipient-ratio in living organ donation.

Female↗
PubMed2006

Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies.

Despite a dramatic decline in mortality over the past three decades, coronary heart disease is the leading cause of death and disability in the U.S. Importantly, recent advances in the field of cardiovascular medicine have not led to significant declines in case fatality rates for women when compared to the dramatic declines realized for men. The current review highlights gender-specific issues in ischemic heart disease presentation, evaluation, and outcomes with a special focus on the results published from the National Institutes of Health-National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. We will present recent evidence on traditional and novel risk markers (e.g., high sensitivity C-reactive protein) as well as gender-specific differences in symptoms and diagnostic approaches. An overview of currently available diagnostic test evidence (including exercise electrocardiography and stress echocardiography and single-photon emission computed tomographic imaging) in symptomatic women will be presented as well as data using innovative imaging techniques such as magnetic resonance subendocardial perfusion, and spectroscopic imaging will also be discussed.

Female↗
PubMed1996

Do women want women health workers? Women's views of the primary health care service.

This paper sets out to explore key aspects of women's views of women GPs and practice nurses within primary health care settings. The extent to which women actively seek female health workers for the provision of their primary health care needs, including preventive health care, is examined. The findings presented in this paper are from a 3-year research project employing both quantitative and qualitative methods, which aimed to develop an understanding of the role women primary health care workers play in the construction and provision of primary health care services for women. The findings indicate that for specific 'women's health issues' the gender of the worker is clearly important for women. However, for other health needs factors such as the personal approach of the provider become paramount. Consideration of the role of the practice nurse suggests that there is considerable potential for practice nurses to further develop a specific role with women. Although lack of awareness among women of nursing skills and expertise raises issues for the presentation of the role of the practice nurse within the primary health care service. In conclusion the paper highlights that women's views should be understood in terms of a complex range of preferences and needs.

Adult↗
PubMed2000

Key emotional issues for couples of mixed HIV status.

With more effective treatment advances, long term HIV survivors are turning their attention back towards career and relationship. Based on a research study (N = 82) this article provides a preliminary overview of the key emotional experiences of being in a primary relationship of mixed HIV status. The article reviews relevant literature on emotional stresses and challenges facing the individual in such a relationship and reports on the study's quantitative and qualitative findings on the subject. Regardless of serostatus, sexual orientation or gender, key issues clearly emerged for this population. They are fearful of HIV transmission, impact of uncertainty, an increase in emotional closeness due to HIV as well as an inevitable emotional distance due to the difference in HIV status. Secondary issues included reproductive dilemmas and struggles given one partner's HIV status and difficulty with disclosing a partner's HIV positive status to others. Implications for social workers in health care are provided.

Adaptation, Psychological↗
PubMed2003

Gender-related concerns of rural women with severe and persistent mental illnesses.

This study used focus groups to investigate the perceptions of rural women with severe and persistent mental illness (SPMI) about their gender-related health concerns. In a series of five focus groups conducted with 16 women at rural psychosocial clubhouses, women with SPMI discussed many gender-related issues, including unresolved grief over loss of children, isolation from family members, lack of sexual partners, diminished sexuality, and bodily changes secondary to medication side-effects. Women with mental illness felt like their roles as women was superseded by their role as mentally ill individuals. Rural women with SPMI have unmet needs for women's health. Psychiatric nurses have the optimal background for addressing gender-related concerns of rural women with SPMI.

Adaptation, Psychological↗
PubMed2001

Cancer and the spouse: gender-related differences in dealing with health care and illness.

There is a universal assertion that everyone has the right to an adequate standard of physical and mental well-being. Notwithstanding this assertion, different behaviors, responses to stressful events, environmental experiences, and biological processes are seen as contributing factors to individual variations in health and well-being. Until recently, medical treatment for women has been based on a male model, without regard to the fact that women perceive and react differently from men to treatments or that some diseases manifest themselves differently in women and men. In this paper, we review research outcomes and theoretical issues of gender differentiation in illness behavior and psychological behavior of cancer patients and their partners. It is time for the gender-bias paradigm to be re-examined and redefined.

Adaptation, Psychological↗
PubMed1998

Sexuality, dementia and residential care: managers report and response.

There is a growing literature on the subject of sexuality and an increased knowledge of sexuality and older people, but there is a dearth of information about sexuality and people with dementia, particularly those in residential care. The concern of this paper is with people with dementia; it also considers the impact of gender on their sexual expression. The expression of sexuality by people with dementia is an area which has been largely neglected by research, yet in practice appears to be of concern. The types and prevalence of sexual expression by people with dementia in residential care and staff's responses to such expression are examined. A postal questionnaire sent to managers of social work residential homes in one region in Scotland explored a number of different issues, including: the public versus private expression of sexuality by people with dementia, the public response versus the private feelings of managers to such expression, the influence of carer involvement on staff's responses, exploitation of one resident by another and sexual expression directed at staff by residents. Permeating all these was the issue of gender. The majority of homes were staffed predominantly by female managers and female care staff. Most residents were female yet the majority of incidents involving sexual expression, reported by managers, involved male residents directing their attention towards female staff or other residents. Female residents with dementia do express sexuality but numbers reported are considerably less with staff actions tending towards the protective. Some types of sexual expression appear to be of more concern than others, and some are reported to occur more frequently.

Journal Article↗
PubMed2005

Gender, ageing, and injustice: social and political contexts of bioethics.

There has been considerable work in bioethics addressing injustice and gender oppression in the provision of healthcare services, in the interaction between client and healthcare professional, and in allocation of healthcare services within a particular hospital or health service. There remain several sites of continued injustice that can only be addressed adequately from a broader analytical perspective, one that attends to the social and political contexts framing healthcare policy and practice. Feminist bioethicists have a strong track record in providing this kind of analysis. Using current Australian aged care and welfare policy this paper demonstrates some of the ways in which issues of gender, age, and social inequity shape bioethical debate, policy, and practice in the areas of aged care and welfare provision. The author develops an argument that demonstrates the gender injustice underlying health care and welfare policy. This argument recognises the inevitability of human dependency relations, and questions the adequacy of current political theories to address the requirements for full and equal citizenship. The author shows that an adequate analysis of the ethics of aged healthcare depends on sufficient consideration of the social and political context within which healthcare policy is framed and an adequate understanding of human dependency.

Aged↗
PubMed1996

Prevention implications of AIDS discourses among South African women.

Social constructionist and feminist analyses have done much to extend the understanding of AIDS beyond the biomedical to include social accounts of the constitution of AIDS knowledge and meanings. However, these frameworks have not translated easily into realistic responses to the paradox of women being seen as responsible for HIV prevention, while they lack the power to implement safe sex behavior. This study explores the range and interplay of discursive themes which South African women drew on regarding AIDS and identifies constraints and opportunities for realistic prevention. The research involved 14 focus group discussions with women. Two main interpretative repertoires regarding AIDS were identified from the texts: one concerning the medicalization and the other the stigmatization of the disease. Although these representations were not unchallenged, the pervasive sense was of denial of own risk, fear, and fatalism. However, the analysis highlighted the complexity of issues to be faced in developing effective prevention initiatives.

AIDS Serodiagnosis↗
PubMed2000

Understanding men's health and illness: a gender-relations approach to policy, research, and practice.

Men's health has emerged as an important public concern that may require new kinds of healthcare interventions and increased resources. Considerable uncertainty and confusion surround prevailing understandings of men's health, particularly those generated by media debate and public policy, and health research has often operated on oversimplified assumptions about men and masculinity. A more useful way of understanding men's health is to adopt a gender-relations approach. This means examining health concerns in the context of men's and women's interactions with each other, and their positions in the larger, multidimensional structure of gender relations. Such an approach raises the issue of differences among men, which is a key issue in recent research on masculinity and an important health issue. The gender-relations approach offers new ways of addressing practical issues of healthcare for men in college environments.

Gender Identity↗
PubMed1992

When theory and practice diverge: gender-related patterns of referral to psychoanalysts.

This study tests the hypothesis that female analysts, relative to male analysts, receive a disproportionately small percentage of male referrals. Referral patterns for 170 analysts from four institutes accredited by the American Psychoanalytic Association were examined. One thousand, five hundred and ten patients referrals were studied. The findings were extremely robust and offered dramatic confirmation of our hypothesis. The major implications of the study are as follows: (1) Women analysts receive relatively few adult male referrals, making it difficult for them to gain requisite clinical experience with men. (2) Analysts and nonanalysts alike demonstrate a reluctance to refer male patients to female analysts. (3) Adult referrals, including those made by analysts, are significantly influenced by the issue of gender match between patient and analyst. (4) Analysts' behavior with regard to making referrals does not correspond to explicit clinical theory regarding how analysts make referrals--specifically, the extent to which gender influences the referral process is not adequately described by theory. We believe that these findings are of some concern from the standpoint of analytic education and that they also raise questions regarding unacknowledged aspects of how gender match between patient and analyst enters into clinical decision making.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Theorizing oppression: implications for nursing research on violence against women.

The way in which oppression is theorized is critical to nursing research in general and nursing research on violence against women in particular. Violence is not just the aberrant behaviour of some men, or a simple issue of gender oppression; rather, it is a complex, pervasive social problem that arises from and is sustained by multiple sites of oppression, including race, class, and gender. Conceptualizations of violence that neglect analyses of power, oppression, agency, and resistance may serve to support and sustain violence; thus their use in nursing research can align nursing with structures that perpetuate violence and oppression. Theories of violence that are informed by complex analyses of power and oppression focus inquiry on the social causes of violence; require analysis of racism, sexism, and classism; and establish, as a goal of research, the countering of oppression by individuals, institutions, and the state. Analyzing oppression as simultaneity guides nursing research into violence against women toward social change, is applicable beyond the issue of violence, and can help nursing contribute to the eradication of the social causes of health problems.

Battered Women↗
PubMed1996

Women and tuberculosis.

Tuberculosis is the leading infectious cause of death in women worldwide. The disease poses a major threat to women's health security. Population growth, the HIV epidemic, increasing poverty and rising levels of drug resistance will inevitably increase the burden of this disease in women. Women are at increased risk of progression to disease during their reproductive years. However, in most low-income countries, twice as many men are notified with tuberculosis as women. Biological mechanisms may account for most of this difference but socioeconomic and cultural factors leading to barriers in accessing health care may cause under-notification in women. Tuberculosis control programmes should be sensitive to the constraints faced by women in accessing health care, in order to empower women to commence and complete treatment. The fear and stigma associated with tuberculosis have a greater impact on women than on men, often leaving them in a more precarious social and economic position. Tuberculosis in women creates orphans, impoverished families and reduces the economic development of society. Tuberculosis is a major cause of preventable suffering and death in women. WHO's recommended tuberculosis control strategy, DOTS, represents a cost-effective response to the problem of tuberculosis in women. Tuberculosis is a major women's health issue. It is a global health priority that tuberculosis treatment be made available to women, particularly to those in low-income countries who are bearing the brunt of this epidemic.

AIDS-Related Opportunistic Infections↗