Women & health
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Applying the principles of harm reduction within the context of incarcerated populations raises a number of challenges. Although some access to harm reduction strategies has been promoted in general society, a divide between what is available and what is advocated continues to exist within the prison system. This paper explores the perceptions and lived experiences of a sample of nationally incarcerated women in Canada regarding their perceptions and experiences in accessing HIV and Hepatitis C prevention, care, treatment and support. ⋯ Despite the implementation of some harm reduction techniques, women in Canadian prisons reported variable access to both education and methods of reducing HIV/HCV transmission. Concerns were also raised about pre-and post-test counseling for HIV/HCV testing. Best practices are suggested for implementing harm reduction strategies within prisons for women in Canada.
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Comparative Study
Disparities in women's health and health care experiences in the United States and Israel: findings from 1998 National Women's Health Surveys.
Using data from bi-national 1998 surveys of adult women in the U.S. and in Israel, this article examines health, access, and care experiences among women in two countries with very different health care systems. We examine how well each country's system serves those vulnerable due to lower socio-economic status. The Israeli health care system-characterized by universal coverage for all its residents-relies on a system of competing health funds that employ many features typical of U.S. managed care plans. The analysis explores the extent to which such a system helps to equalize access experiences with contrasts to the experiences of U.S. women. ⋯ The findings indicate that achieving more equitable access to health care requires attention to non-financial as well as financial barriers to care. Despite the lack of financial barriers to care in Israel, administrative controls typical of managed care organizations appear to make health care systems difficult to navigate for low income and less educated women. The finding that disparities in health persist in a country with universal coverage indicates that improving women's health will require attention to broader social influences on health as well as improving access to health care.
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Few studies have examined the challenges facing physician activists: health care providers who engage in unpaid, non-clinical work to effect change in social issues pertaining to public health. We conducted focus groups with 19 health care providers active in violence prevention; data were analyzed using qualitative methods. Five themes emerged: (1) personal experience had generated participants' activism; (2) physicians believed they were uniquely qualified as violence prevention activists; (3) violence prevention inside the health care setting often overshadowed outside activism; (4) they feared being overwhelmed by demands of activism; and (5) they felt isolated and valued networking, especially locally, to relieve isolation. Findings illustrate the complex demands of violence prevention work on today's busy physicians.
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Even though current domestic violence guidelines, such as those published by the AMA in 1992, attempt to relieve physicians of the "full burden of intervention," they continue to call upon physicians to play a large role in identifying, intervening in, and following up on case of partner abuse. In this paper, we define a limited domestic violence role for physicians which furthers the direction recommended by the AMA and which complements exemplary programs. We propose simplifying and limiting physicians' tasks to Asking patients about abuse; providing Validating messages, acknowledging that battering is wrong and confirming patient worth; Documenting presenting signs, symptoms, and disclosures; and Referring victims to domestic violence specialists (AVDR). By drawing on the literature and our own experience, we show how focusing the physician's role on these four taks is consistent with exemplary programs and expands on ideas put forth by experts for addressing domestic violence in health care settings; reduces barriers for physician interventions with victims; offers a realistic approach for physicians, reducing unrealistic educational demands; and complements managed care trends in contemporary health care.
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Comparative Study
Domestic violence in later life: an overview for health care providers.
Domestic violence is a significant problem that adversely affects the health and safety of millions of women throughout their life-span. Most cases of what is considered elder abuse occurs at home rather than in institutions, and the evidence suggests that only 1 in 5 cases are recognized. ⋯ Improving the ability of physicians to identify domestic violence is an important skill needed for establishing comprehensive intervention and prevention efforts. In addition to conducting universal screening of all female patients, using clinical and behavioral indicators is a critical component of the intervention.