Journal of urban health : bulletin of the New York Academy of Medicine
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Hispanic/Latino persons are disproportionately impacted by HIV in the US, and HIV diagnoses among Hispanic/Latino men in Georgia have increased over the past decade, particularly in metropolitan Atlanta. In 2022, the Georgia Department of Public Health detected five clusters of rapid HIV transmission centered among Hispanic/Latino gay, bisexual, and other men who have sex with men (HLMSM) in metropolitan Atlanta. We conducted in-depth interviews with 65 service providers and 29 HLMSM to identify barriers and facilitators to HIV service access for HLMSM. ⋯ Finally, the HLMSM community is characterized by its diversity, and there is not a one-size-fits-all approach to providing appropriate care to this population. The collection of qualitative data during an HIV cluster investigation allowed us to quickly identity barriers experienced by HLMSM when accessing HIV and other medical care, to optimize public health response and action. Well-designed program evaluation and implementation research may help elucidate specific strategies and tools to reduce health disparities, ensure equitable service access for HLMSM, and reduce HIV transmission in this population.
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This article uses ethnographic and qualitative research to explore the health implications and social responses of a low-income neighborhood in Southeast England, to more than a decade of austerity policies and declining institutional and welfare support. Findings examine how cuts to public services and welfare programs alongside changes to the area's social structure shape resident's perceptions of health risks and threats. Residents pointed to poor levels of mental health that were exacerbated by financial insecurity, the closure of community facilities and difficulties accessing support and professional help. ⋯ Many people felt their neighborhood was treated inequitably with regard to law-and-order, health provision and other services designed to address health problems and risks and dangers in their social environment. This institutional vacuum generates unmet health needs facilitating informal practices and methods for managing health, such as through self-provision or using alternative, and more readily available, sources of medical advice and treatment. The demise of older forms of social control and surveillance that ran parallel with closure of the area's communal spaces had been partly compensated by social media usage, while informal methods of policing were a growing presence in the neighborhood in reaction to rising lawlessness and the ineffectiveness of police and local authorities.
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We used the 2021 Policing in America Survey to examine experiences with police and perceptions of policing in Cook County, IL, and Dallas County, TX. Substantial portions of residents believe that local police use force during at least half of arrests (Cook 45.8%, Dallas 52.2%) and report dissatisfaction with local policing efforts (Cook 49.0%, Dallas 48.5%). Black and Hispanic residents in both communities were more likely than white, non-Hispanic residents to have frequent use of force expectations and dissatisfaction with police. ⋯ Negative experiences with police (Cook aOR = 10.73; Dallas aOR = 12.11), witnessing misconduct (Cook aOR = 3.87; Dallas aOR = 3.55), and feeling unsafe in one's neighborhood (Cook aOR = 4.56; Dallas aOR = 3.49) were independently associated with greater odds of dissatisfaction. Inequities in exposure to unsafe neighborhoods, witnessing misconduct, and negative interactions with police are key drivers of variation in expectations and perceptions of police. Optimizing transparency and assurances of procedural justice are needed to reduce fear and increase satisfaction with police in the USA.
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Transgender and gender-diverse communities are disproportionately incarcerated in the USA. Incarcerated gender minority populations are detained within carceral systems constructed around a cisgender (gender identity matches sex assigned at birth) binary (only male and female identities recognized) understanding of gender. This leads to marginalizing experiences while perpetuating the extreme vulnerability individuals experience in the community. ⋯ This includes ensuring access to gender-affirming clinical care that aligns with community health standards recommended by medical professional associations. Implementing gender-affirming reforms reduces security issues and will likely improve health outcomes providing mutual benefit for both correctional staff and gender minority populations. Given the current divisive political and social environment for gender minority populations in the USA, evidence-based person-centered reforms in corrections are needed now more than ever.
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Gun-related violence exposure is a significant public health problem for urban youth. Few studies have implemented methods to estimate the spatial influence of activity spaces on gun violence exposure constrained by the physical configuration of walkable street networks. The present research uses computational network and local indicators of spatial autocorrelation methods to explore gun violence exposure along the walkable streets near schools in Compton, California. ⋯ Almost all schools had at least one shooting within a 5-min walk (i.e., about 400 m); 37.8% of schools had an average shooting distance of less than 400 m; about 250 incidents occurred within 5 min of schools; and about 30 schools had a shooting within a 5-min walking distance. Determining the spatial extent of violence exposure in proximity to key activity spaces for youth, such as schools, has substantial implications for the health and wellbeing of youth living in violence-prone areas. The public health and legal implications of this study are discussed in context.