Awareness and attitudes of prescribing pre-exposure prophylaxis for HIV prevention among medical providers in Guatemala: Implications for country-wide implementation

: 2.052_NEP The relationship between social and institutional gender inequality and suicide rates of young women across the globe A. Pugh, J. Contreras, B. Kneable, S. Talboys Background: This study seeks to analyze the relationship between suicide rates of young women around the world. The Social Index and Gender Index, or SIGI, offers a measure of the upstream social and structural inequalities in world countries. We seek to discover the areas of discrimination against women that are significantly correlated to the prevalence of female suicide. Methods: We investigated the relationship between suicide rates of women 15-29 around the world and the relative gender discrimination experienced in their country as rated by the SIGI. This is an ecological study at the country-level using publicly available data from the WHO on suicide rates and the OECD’s SIGI data from 2012. We examined the bivariate correlations of between suicide and SIGI composite and sub-component measures using robust regression models and used Spearman rank correlation coefficient. Findings: The female suicide ratio (to males) was positively correlated with the SIGI (0.72 (0.21-1.24) p1⁄40.006) and all of its subcomponents except physical integrity. Sub-component correlations included family code (0.67 (0.24-1.11) 0.003), physical integrity (0.01 (-0.23-0.24) 0.958), son bias (0.92 (0.38-1.46) 0.001), access to resources (0.29 (0.05-0.53) 0.019) and civil liberties (0.22 (0.030.42) 0.024). Secondly, we found a significant negative correlation with SIGI and male suicide rate (-12.19 (-23.93d0.44) 0.04), but no correlation for female suicide rates. Interpretation: It’s important to consider the role of gender inequalities and suicide in order to understand the effect that gender discrimination may have on women’s mental health and how severe that impact can be. The findings do not show direct causation but do offer findings that merit further study and a deeper depth of understanding. These findings may explain the negative impact that discrimination in family code and son bias can have on women’s health. Asia may have a high ratio of female to male suicide in part because of their problems with son bias and family discrimination.


Methods:
We investigated the relationship between suicide rates of women 15-29 around the world and the relative gender discrimination experienced in their country as rated by the SIGI. This is an ecological study at the country-level using publicly available data from the WHO on suicide rates and the OECD's SIGI data from 2012. We examined the bivariate correlations of between suicide and SIGI composite and sub-component measures using robust regression models and used Spearman rank correlation coefficient.
Interpretation: It's important to consider the role of gender inequalities and suicide in order to understand the effect that gender discrimination may have on women's mental health and how severe that impact can be. The findings do not show direct causation but do offer findings that merit further study and a deeper depth of understanding. These findings may explain the negative impact that discrimination in family code and son bias can have on women's health. Asia may have a high ratio of female to male suicide in part because of their problems with son bias and family discrimination. Purpose: In the realm of global health, providing care and education is crucial. With a widening spectrum of health issues but a narrow pool of resources, it is important to ensure that the resources provided are relevant to the population and time-period. This requires consistent assessment of the population's needs. This study aims to identify and help refine the kind of care and health education needed in Cono Sur, Lima, Peru through a needs-based assessment. Data were obtained from mobile clinics in the Cono Sur. An orally administered survey was compared against nurse reported diagnosis rates for each diagnostic category.
Outcome & Evaluation: Clinic staff diagnosed 311 patients in a 6 month period. In total, 68 patients (22M, 46F) participated in the survey. Thirty-six percent of participants did not feel they had access to healthcare, and 74% of participants reported difficulty in paying for healthcare. Sixty-three percent of participants said they have difficulty paying for medications.
A one-way between-groups ANOVA was conducted, and showed that our results were significant (F (9,11)¼ 8.5, p¼0.001) for a difference between the number of people diagnosed with a disease and the number of people that reported that disease as their primary health concern in a list of disease categories. Patient concerns were often directed towards life-ending medical problems, such as cancer and family history (27% and 13%, respectively), which were overrepresented compared to clinic diagnoses (5%). Chronic medical conditions and other silent diseases, on the other hand, were an underreported concern (chronic: 23% diagnosed, 8% concerned; other: 40% diagnosed, 5% concerned). These results, in combination with only 42% of patients taking medications for their chronic illnesses, and the majority of patients who lacked knowledge or wanted to learn more about their illnesses, prompts the need for increased education in these areas. In addition, the community's main concerns need to be addressed to decrease fear of rare fatal conditions. will require that medical providers are knowledgeable and willing to prescribe PrEP. We sought to explore current PrEP awareness and prescribing attitudes among Guatemalan physicians.
Methods: We conducted a cross-sectional survey of adult medicine physicians at Roosevelt Hospital in Guatemala City in April 2015. The survey included demographics, specialty, years of HIV patient care, PrEP awareness, willingness to prescribe PrEP, previous experiences with post-exposure prophylaxis (PEP), concerns about PrEP, and general knowledge and practice of other HIV prevention methods. The primary outcome, willingness to prescribe PrEP, was assessed using a 5-point Likert scale for different patient scenarios. Willingness to prescribe was defined as "likely" or "very likely" to prescribe PrEP.
Findings: A total of 87 physicians were surveyed. Participant characteristics included 65% were male, 64% were Internal Medicine residents, and 10% were Infectious Diseases specialists. 69% of providers reported having heard of PrEP. When assessing the level of detail of PrEP awareness, 23% of providers reported having read major PrEP studies while 13.3% reported having previously prescribed PrEP. 86.6% of respondents were willing to prescribe PrEP in the case of a man who has sex with other men, a sex worker, or an HIV-negative person with a known HIV-positive partner. Concerns regarding PrEP included development of resistance (92.1%), risk compensation (89.5%), and high medication costs (63.9%). Univariate analysis showed no significant association between willingness to prescribe PrEP and PrEP awareness.
Interpretations: Guatemalan providers at a large public hospital were aware of PrEP and willingness to prescribe PrEP was high. Provider education should address concerns including potential for drug resistance, risk compensation and access to medications. Our findings suggest willingness and potential implementation opportunities for PrEP rollout in Guatemala. There has been growth in innovative university programming that focuses on social justice and teaches community-based strategies that are applicable both domestically and internationally. However, the concepts underlying global/local education are undertheorized and universities struggle to make the global/local link without a conceptual framework to guide them in this pursuit.
Structure/Method/Design: The purpose of the 2015 meeting, "Global/Local: What does it mean for global health educators and how do we do it?" was to discuss the background and themes of the global/local movement and develop a proposed list of global/ local program elements. The meeting consisted of plenary lectures, lightening presentations, and structured small group discussions with note takers. The comments were distilled and categorized by the meeting organizers to reach a preliminary set of elements that are critical for a successful global/local program.
Outcome & Evaluation: Based on the comments of the meeting participants, the organizers developed seven preliminary components of an effective global/local program and recommendations for future study. The conclusions and how they were reached will be set forth in a published article that can be used by global health educators to understand the conceptual link between learning on the global level and on the community level. The proposed article will assist global health and community engagement educators to develop programs that expose students to global themes of social justice and health equity and the importance of developing appropriate local solutions wherever they are needed. Sound global/local program will break down the artificial divide between global health and domestic community engagement efforts and the university institutions, funding options, and career pathways that flow from the divide.
Going Forward: Future research should focus on implementation of global/local programing and evaluation of student learning and community health outcomes.
Funding Source: USAID Global Health Fellows Program II and University of Maryland Baltimore Center for Global Education Initiatives.

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University of Sydney, Parramatta, New South Wales, Australia Background: Recent evidence suggests there is a role for the dental team, particularly dentists in offering chairside HIV screening to patients during the dental appointment. HIV is no longer a death sentence with early diagnosis and effective treatment contributing a good prognosis. This abstract highlights the international evidence that supports dentists' willingness to conduct HIV screening.
Methods: Cross-sectional surveys of practicing dentists were conducted in Australia (n¼532), China (n¼477), and India (n¼503), in addition to a mixed methods survey and focus groups (FG) in