Journal of urban health : bulletin of the New York Academy of Medicine
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The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. ⋯ Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.
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Black women are disproportionately impacted by HIV and depression has been linked to negative HIV outcomes. Little attention has been given to social/structural factors that may drive depression among Black women living with HIV (BWLWH), including discrimination and gendered racial microaggressions (GRM). ⋯ GRM and race- and HIV-related discrimination were significantly associated with depressive symptoms and increased likelihood of MDE, but only GRM contributed uniquely in associations with both. Interventions targeting depression among BWLWH should address GRM and race- and HIV-related discrimination.
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A recent article by Corburn et al. lays out the policies that would help slum communities in the global south deal with COVID-19. That article notes the vulnerabilities of people in these informal settlements and argues that any assistance program must recognize these realities so that the policies do not further jeopardize the survival of large segments of the population of these communities. This note extends the arguments in that paper, focusing on some of the logistic issues involved in providing assistance to informal settlements. ⋯ Because of the location and occupation of most of the residents of these communities, targeting them simultaneously addresses health and economy-wide concerns generated by COVID-19. Their characteristics make them much more likely to be afflicted by the virus and spread it to others. The main conclusions of this note with respect to policy are that the scale of such assistance is likely to be larger than has so far been proposed, that in countries with limited testing ability slums provide one of the most effective places to target assistance, that the role of community groups in providing the assistance is difficult to exaggerate, and that philanthropy has a role to play in supporting innovation.
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The present study examined the association of residential instability with hospitalizations among homeless and vulnerably housed individuals over a 4-year time period. Survey data were linked to administrative records on hospitalizations. Specifically, we used data from the Health and Housing in Transition study, a prospective cohort study that tracked the health and housing status of homeless and vulnerably housed individuals in Canada. ⋯ A higher number of residential moves were associated with hospitalization over the study period (adjusted odds ratio: 1.14; 95% confidence interval: 1.01, 1.28). Transgender, female gender, perceived social support, better self-reported mental health, and having ≥ 3 chronic health conditions also predicted having been hospitalized over the study period, whereas high school/higher education was negatively associated with hospitalizations. Our results indicate that residential instability is associated with increased risk of hospitalization, illustrating the importance of addressing housing as a social determinant of health.