Journal Article > ResearchFull Text
Soc. Sci. Med. 1993 August 1
Schopper D, Doussantousse S, Orav J
Soc. Sci. Med. 1993 August 1
KAP surveys have been proposed as a means to gather quantitative information on AIDS-related sexual behaviors, but the validity of survey results has not been tested. The validity of data gathered during a KAP survey in a rural district in Northern Uganda (N = 1486) was examined analyzing expected behavioral patterns, agreement of partner reports, and concordance of number of sexual contacts across gender. Patterns of sexual behavior and age trends are as expected. More men (50%) than women (18.5%) reported premarital sex. The likelihood of sexual intercourse before marriage increases with age at first marriage and with education. Women marry 5 years earlier than men, and the number of marriages increases with age. Peak incidence of casual sex occurs before age 25. The male/female ratio of casual sex is 4, as compared to about 3 in other African surveys. Single men are 2.5 times more likely to engage in casual sex than married males. Agreement of partner reports was examined for 392 couples selected by chance. 86% of the couples agreed on being polygamous or monogamous. On average men reported 1.3 (SD = 0.7) wives as compared to women reporting 1.5 (SD = 0.89) wives (P < 0.001). 16.8% of women declared more, and 2.8% less cowives than their husband (r = 0.65). Self-reports on frequency of sexual intercourse in the past month were examined for 256 monogamous couples. Mean frequencies differ (5.24 +/- 5.1 for men, 4.43 +/- 4.7 for women, P < 0.001). 42.8% of couples are in agreement within +/- 1 unit (r = 0.44). The total number of extra-marital and marital sex acts, as well as the total number of partners reported by each gender are similar. There is, however, a striking gender difference in reporting of casual partners in the past year. Data were found to be accurate at the aggregate level. However, accuracy of reporting at the individual level was found to be low. The gender difference in reporting of casual partners may be due to female underreporting, to not having captured prostitutes or to a different perception of the meaning of casual partnership. All KAP surveys should include a validity analysis, so as to provide a sense of the accuracy of the surveys and allow for comparison of the quality of different KAP surveys. There is an urgent need for a standardized approach to validating the findings from AIDS-related KAP surveys. Some of the indirect methods described here could be relevant for further use.
Journal Article > CommentaryFull Text
Soc. Sci. Med. 2015 December 1; Volume 147; DOI:10.1016/j.socscimed.2015.10.063
Calain P, Poncin M
Soc. Sci. Med. 2015 December 1; Volume 147; DOI:10.1016/j.socscimed.2015.10.063
Journal Article > ResearchFull Text
Soc. Sci. Med. 2019 October 18
Bjertrup PJ, Bouhenia M, Mayaud P, Perrin C, Ben Farhat J, et al.
Soc. Sci. Med. 2019 October 18
In 2015, an estimated 856,723 refugees, predominantly from Syria, Afghanistan, and Iraq arrived in Greece as an entry point into the European Union. The border of the Former Yugoslav Republic of Macedonia closed in March 2016, blocking a popular route for refugees through Europe, and left around 60,000 people stranded in Greece.
OBJECTIVE:
A mixed-method study was conducted among refugees in the regions of Attica, Epirus, and Samos between November 2016 and February 2017. The epidemiological survey showed that depending on study sites between 73% and 100% of the refugees suffered from anxiety disorder. The explanatory qualitative study aimed to understand refugees' mental health and narratives of social suffering in regards to experienced violence, the effect of current border closures, and the lack of an onward journey.
METHOD:
The explanatory qualitative study included 47 in-depth interviews and five focus group discussions with refugees purposely recruited through the concomitant epidemiological survey, representing both genders and a range of nationalities and ages. Data were thematically analysed to identify emergent patterns and categories using NVivo 11.
RESULTS:
The refugees overwhelmingly reported experiencing uncertainty and lack of control over their current life and future, which caused psychosocial distress and suffering. The passivity of life in refugee camps aggravated feelings of meaninglessness and powerlessness. The disruption of key social networks and absence of interactions with the surrounding Greek society led to feelings of isolation and being unwelcome.
CONCLUSIONS:
Refugees in Greece experience psychosocial distress and social suffering as a consequence of their uncertain and disrupted lives and the loss of social networks. Faster and transparent asylum procedures, the development of meaningful and empowering activities, and fostered social interactions with the surrounding society would contribute to alleviating their psychosocial suffering.
OBJECTIVE:
A mixed-method study was conducted among refugees in the regions of Attica, Epirus, and Samos between November 2016 and February 2017. The epidemiological survey showed that depending on study sites between 73% and 100% of the refugees suffered from anxiety disorder. The explanatory qualitative study aimed to understand refugees' mental health and narratives of social suffering in regards to experienced violence, the effect of current border closures, and the lack of an onward journey.
METHOD:
The explanatory qualitative study included 47 in-depth interviews and five focus group discussions with refugees purposely recruited through the concomitant epidemiological survey, representing both genders and a range of nationalities and ages. Data were thematically analysed to identify emergent patterns and categories using NVivo 11.
RESULTS:
The refugees overwhelmingly reported experiencing uncertainty and lack of control over their current life and future, which caused psychosocial distress and suffering. The passivity of life in refugee camps aggravated feelings of meaninglessness and powerlessness. The disruption of key social networks and absence of interactions with the surrounding Greek society led to feelings of isolation and being unwelcome.
CONCLUSIONS:
Refugees in Greece experience psychosocial distress and social suffering as a consequence of their uncertain and disrupted lives and the loss of social networks. Faster and transparent asylum procedures, the development of meaningful and empowering activities, and fostered social interactions with the surrounding society would contribute to alleviating their psychosocial suffering.
Journal Article > ResearchFull Text
Soc. Sci. Med. 2021 September 1; Volume 285; 114268.; DOI:10.1016/j.socscimed.2021.114268
de Jong K, Martinmäki SE, Te Brake H, Haagen JFG, Kleber RJ
Soc. Sci. Med. 2021 September 1; Volume 285; 114268.; DOI:10.1016/j.socscimed.2021.114268
Research findings show humanitarian work impacts one's health. We conducted a prospective observational study among 618 international humanitarian aid workers (iHAWs)’ recruited from 76 countries to investigate health changes and ill-health risk factors after mostly short-term (<1 year) medical emergency assignments. The aid workers were assigned to 27 countries. Data collected between 2017 and 2020.
We also compared a gold-standard clinical interview with self-report questionnaires to assess whether self-report scores overestimate the prevalence of clinical anxiety, depression and PTSD. Analyses consisted of repeated measures ANOVAs and adjusted odds ratios, using pre-assignment (T1), post-assignment (T2) and two-month follow-up data (T3). Humanitarian workers experienced on average, 2.6 experienced and witnessed potential traumatic events, and 4.8 male and 5.6 female assignment-related stressors. Self-report health indicators demonstrated a significant increase in emotional exhaustion, loss of vitality, decreased social functioning and emotional well-being between T1 and T2, all of which improved between T2 and T3. PTSD, depression, experienced role limitations, physical functioning, pain, and general health – remained stable. Anxiety levels decreased significantly between T1 and T2. The presence of DSM-5 disorders anxiety (6.6 %), depression (1.3 %) and PTSD (0.3 %) was low compared to norm populations, except for alcohol-use disorder (13 %). None of the reported T2 risk factors was significant at T3. Compared to the clinical interview, self-report cut-off thresholds inflated the presence of a potential anxiety disorder (3×), PTSD (8×) and depression (25×). Humanitarian work is highly stressful but most iHAWs remained healthy. Looking into how iHAWs stay healthy may be a more useful way forward.
We also compared a gold-standard clinical interview with self-report questionnaires to assess whether self-report scores overestimate the prevalence of clinical anxiety, depression and PTSD. Analyses consisted of repeated measures ANOVAs and adjusted odds ratios, using pre-assignment (T1), post-assignment (T2) and two-month follow-up data (T3). Humanitarian workers experienced on average, 2.6 experienced and witnessed potential traumatic events, and 4.8 male and 5.6 female assignment-related stressors. Self-report health indicators demonstrated a significant increase in emotional exhaustion, loss of vitality, decreased social functioning and emotional well-being between T1 and T2, all of which improved between T2 and T3. PTSD, depression, experienced role limitations, physical functioning, pain, and general health – remained stable. Anxiety levels decreased significantly between T1 and T2. The presence of DSM-5 disorders anxiety (6.6 %), depression (1.3 %) and PTSD (0.3 %) was low compared to norm populations, except for alcohol-use disorder (13 %). None of the reported T2 risk factors was significant at T3. Compared to the clinical interview, self-report cut-off thresholds inflated the presence of a potential anxiety disorder (3×), PTSD (8×) and depression (25×). Humanitarian work is highly stressful but most iHAWs remained healthy. Looking into how iHAWs stay healthy may be a more useful way forward.
Journal Article > ResearchFull Text
Soc. Sci. Med. 2023 March 15; Volume 323; 115833.; DOI:10.1016/j.socscimed.2023.115833
James M, Kasereka JG, Kasiwa B, Kavunga-Membo H, Kambale K, et al.
Soc. Sci. Med. 2023 March 15; Volume 323; 115833.; DOI:10.1016/j.socscimed.2023.115833
During the 10th Ebola virus disease (EVD) epidemic in the eastern Democratic Republic of the Congo (DRC) (2018-2020), two experimental EVD vaccines were deployed in North Kivu. This province has been at the centre of conflict in the region for the last 25 years. Amidst ambivalence towards protracted foreign intervention and controversy about introducing two experimental vaccines, the existing literature has focused on mistrust and 'resistance' towards the Ebola response and vaccines. In this article, we examine why people in the eastern DRC did decide to volunteer for a trial of a second EVD vaccine in North Kivu, despite the controversy. Drawing on ethnographic observation, interviews, and focus groups with trial participants conducted between September 2020 and April 2021, we analyse three motivations for participating: protection, health seeking, and expectations surrounding travel requirements. We make three points. First, participation in vaccine trials may be understood locally to have advantages which have not been considered by the trial, because they go beyond medical considerations and are specific to a particular social setting. Second, despite much of the literature focusing on a causal relationship between rumours and 'vaccine hesitancy', some rumours may in fact encourage participation. Third, material objects associated with trial participation - such as participant vaccine cards - can hold social and political meaning beyond the confines of the vaccine clinic, and influence decisions surrounding participation. Empirical investigation of how medical interventions become entangled in political economies is essential to understanding the perceived functions of participation, and thus the reasons why people volunteer in clinical trials. Participants' narratives about their decision-making provide an insight into how international bioethical debates interact with, but may also stand apart from, the situated social and economic realities driving decision-making around clinical trials on the ground. This highlights the need for ethical approaches that foreground the political, social, and economic context.
Journal Article > CommentaryFull Text
Soc. Sci. Med. 2012 July 27; DOI:10.1016/j.socscimed.2012.06.02
Calain P
Soc. Sci. Med. 2012 July 27; DOI:10.1016/j.socscimed.2012.06.02
Media representations of suffering bodies from medical humanitarian organisations raise ethical questions, which deserve critical attention for at least three reasons. Firstly, there is a normative vacuum at the intersection of medical ethics, humanitarian ethics and the ethics of photojournalism. Secondly, the perpetuation of stereotypes of illness, famine or disasters, and their political derivations are a source of moral criticism, to which humanitarian medicine is not immune. Thirdly, accidental encounters between members of the health professions and members of the press in the humanitarian arena can result in misunderstandings and moral tension. From an ethics perspective the problem can be specified and better understood through two successive stages of reasoning. Firstly, by applying criteria of medical ethics to the concrete example of an advertising poster from a medical humanitarian organisation, I observe that media representations of suffering bodies would generally not meet ethical standards commonly applied in medical practice. Secondly, I try to identify what overriding humanitarian imperatives could outweigh such reservations. The possibility of action and the expression of moral outrage are two relevant humanitarian values which can further be spelt out through a semantic analysis of 'témoignage' (testimony). While the exact balance between the opposing sets of considerations (medical ethics and humanitarian perspectives) is difficult to appraise, awareness of all values at stake is an important initial standpoint for ethical deliberations of media representations of suffering bodies. Future pragmatic approaches to the issue should include: exploring ethical values endorsed by photojournalism, questioning current social norms about the display of suffering, collecting empirical data from past or potential victims of disasters in diverse cultural settings, and developing new canons with more creative or less problematic representations of suffering bodies than the currently accepted stereotypes.
Journal Article > ResearchFull Text
Soc. Sci. Med. 2018 July 1; Volume 209; 86-94.; DOI:10.1016/j.socscimed.2018.05.038
Arsenijević J, Burtscher D, Ponthieu A, Severy N, Contenta A, et al.
Soc. Sci. Med. 2018 July 1; Volume 209; 86-94.; DOI:10.1016/j.socscimed.2018.05.038
During 2015 and 2016, an unprecedented flow of approximately 800,000 migrants coming from Turkey towards Western Europe crossed the Balkans. Male migrants are perceived as being less vulnerable compared to other migrants and they are not given priority in service and support provision. This qualitative study examines the self-perceived vulnerabilities of male migrants travelling alone along the Balkan route to Europe. Twenty-four individual in-depth interviews, two group interviews and participant observation were conducted with male migrants in Belgrade, Serbia in 2017. Data was coded manually, and analysed thematically. Male migrants traveling alone face the cumulative vulnerability of various traumatic events and migration-related contextual circumstances. Three main themes emerged: the ongoing desperate journey, the better treatment of 'traditionally' well recognised vulnerable sub-groups and the impact of the continuous stress on mental health. Deterrence measures imposed for border control purposes in the form of push-backs, expulsions, detention and degrading, inhumane treatment amplify the psychological distress of male migrants. Feelings of hopelessness, desperation, lack of self-value and self-esteem were reported. 'Traditionally vulnerable' populations were said to have had better treatment throughout the journey from smugglers, border state authorities, governmental officials, civil society and international organizations. The devastating experiences of male migrants, as well as the better treatment offered to other groups of migrants like women and children, results in a perceived neglect of the needs of men in humanitarian response, rendering them vulnerable and exposing them to further health and protection risks. In a context where needs are unmet and people's dignity and health are at risk, specific strategies should be developed to include men in the assistance and protection offered, particularly in relation to exposure to violence.