Despite progress in COVID-19 vaccination rates overall in the US and UK, vaccine inequity persist... more Despite progress in COVID-19 vaccination rates overall in the US and UK, vaccine inequity persists as young people from minoritised and/or deprived communities are often less likely to be vaccinated. COVID-19 ‘vaccine hesitancy’ is not just an issue of misinformation or lack of information. ‘Vaccine hesitancy’ among young people is reflective of wider issues such as mistrust in the state or the medical establishment and negative experiences during the pandemic. This report is based on case study research conducted among young people (ages 12-18) in Cleveland, Ohio, US and the London borough of Ealing, UK. Whilst public discourse may label young people as ‘vaccine hesitant,’ we found that there were differences based on social location and place and this labelling may portray young people as ‘ignorant.’ We found the greatest vaccine hesitancy among older youth (15+ years old), particularly those from minoritised and deprived communities. Unvaccinated youth were also more likely to be...
Efforts to expand access to HIV care and treatment often stress the importance of disclosure of H... more Efforts to expand access to HIV care and treatment often stress the importance of disclosure of HIV status to aid adherence, social support, and continued resource mobilization. We argue that an examination of disclosure processes early in the process of seeking testing and treatment can illuminate individual decisions and motivations, offering insight into potentially improving engagement in care and adherence. We report on baseline data of early HIV disclosure and nondisclosure, including reasons for and responses to disclosure from a cohort of men and women (n=949) currently accessing antiretroviral treatment in two regions of Uganda. We found early disclosures at the time of suspicion or testing positive for HIV by men and women to be largely for the purposes of emotional support and friendship. Responses to these selected disclosures were overwhelmingly positive and supportive, including assistance in accessing treatment. Nonetheless, some negative responses of worry, fear, or social ostracism did occur. Individuals deliberately chose to not disclose their status to partners, relatives, and others in their network, for reasons of privacy or not wanting to cause worry from the other person. These data demonstrate the strategic choices that individuals make early in the course of suspicion, testing, and treatment for HIV to mobilize resources and gain emotional or material support, and similarly their decisions and ability to maintain privacy regarding their status.
Twenty-two families with one or more adult members with AIDS were extensively interviewed about s... more Twenty-two families with one or more adult members with AIDS were extensively interviewed about sociodemographic variables, knowledge of AIDS, responses to AIDS, material needs, psychological state and perception of stigma. A total of 24 individuals were enrolled. Seven subjects did not permit contact with family members. Of the 24 subjects, four denied that they have AIDS, four informed everyone in the household of the AIDS diagnosis, eight told no one at all, and eight told some of their family. Subjects reportedly did not tell their family because the family would worry, they feared rejection, it is none of their business or they wouldn't understand. Family members expressed fear of loss, shock and disbelief at the diagnosis, but did not reject the subject or fear infection. Persons with AIDS and their families expressed fear of rejection from those outside the household due to the perceived stigma associated with AIDS. The labelling of someone as having AIDS relates to their physical condition, so with declining health, subjects and their families may avoid outside contacts. A direct impact of AIDS is to diminish mobility, decreasing available economic resources. These data indicate the importance of assisting families responsible for caring for AIDS patients.
Introduction: Targeting most-at-risk individuals with HIV preventive interventions is cost-effect... more Introduction: Targeting most-at-risk individuals with HIV preventive interventions is cost-effective. We developed genderspecific indices to measure risk of HIV among sexually active individuals in Rakai, Uganda. Methods: We used multivariable Cox proportional hazards models to estimate time-to-HIV infection associated with candidate predictors. Reduced models were determined using backward selection procedures with Akaike's information criterion (AIC) as the stopping rule. Model discrimination was determined using Harrell's concordance index (c index). Model calibration was determined graphically. Nomograms were used to present the final prediction models. Results: We used samples of 7,497 women and 5,783 men. 342 new infections occurred among females (incidence 1.11/100 person years,) and 225 among the males (incidence 1.00/100 person years). The final model for men included age, education, circumcision status, number of sexual partners, genital ulcer disease symptoms, alcohol use before sex, partner in high risk employment, community type, being unaware of a partner's HIV status and community HIV prevalence. The Model's optimism-corrected c index was 69.1 percent (95% CI = 0.66, 0.73). The final women's model included age, marital status, education, number of sex partners, new sex partner, alcohol consumption by self or partner before sex, concurrent sexual partners, being employed in a high-risk occupation, having genital ulcer disease symptoms, community HIV prevalence, and perceiving oneself or partner to be exposed to HIV. The models optimism-corrected c index was 0.67 (95% CI = 0.64, 0.70). Both models were well calibrated. Conclusion: These indices were discriminative and well calibrated. This provides proof-of-concept that population-based HIV risk indices can be developed. Further research to validate these indices for other populations is needed.
Background In 2006, Uganda adopted the Reaching Every District strategy with the goal of attainin... more Background In 2006, Uganda adopted the Reaching Every District strategy with the goal of attaining at least 80% coverage for routine immunizations in every district. The development and utilization of health facility/district immunization microplans is the key to the strategy. A number of reports have shown suboptimal development and use of microplans in Uganda. This study explores factors associated with suboptimal development and use of microplans in two districts in Uganda to pinpoint challenges encountered during the microplanning process. Methods A qualitative study was conducted comparing two districts: Kapchorwa, with low immunization coverage, and Luwero with high immunization coverage. Data were collected through multilevel observation of health facilities, planning sessions and planning meetings; records review of microplans, micromaps and meeting minutes; 57 interviews with health workers at the ministry level and lower-level health facility workers. Data were analysed us...
... Clearly a focus on the economic context within which AIDS risk reduction be-haviors occur is ... more ... Clearly a focus on the economic context within which AIDS risk reduction be-haviors occur is critical (Rwabukwali et al. 1991; Schoepf 1988; Schumann et al. 1991, 1992). ... 161 Obbo, Christine African Women: Their Struggle for Economic Independence. London: Zed Press. ...
Antiretroviral treatment programs, despite biomedical emphases, require social understanding and ... more Antiretroviral treatment programs, despite biomedical emphases, require social understanding and transformations to be successful. In this paper, we draw from a qualitative study of HIV treatment seeking to examine the drug taking routines and health-related subjectivities of men and women on antiretroviral treatment (ART) at two sites in Uganda. We show that while not all participants in ART programs understand clinical protocols in biomedical terms, they adopt treatment taking strategies to integrate medication into daily practices and social spaces. In turn, these embedded practices and understandings, shape long term hopes and fears for living with HIV, including the possibility of a cure. More significant than new forms of citizenship or sociality, the authors suggest that quotidian dimensions of treatment normalization shape the long term experience of medication and outlook for the future. This article is protected by copyright. All rights reserved.
Despite progress in COVID-19 vaccination rates overall in the US and UK, vaccine inequity persist... more Despite progress in COVID-19 vaccination rates overall in the US and UK, vaccine inequity persists as young people from minoritised and/or deprived communities are often less likely to be vaccinated. COVID-19 ‘vaccine hesitancy’ is not just an issue of misinformation or lack of information. ‘Vaccine hesitancy’ among young people is reflective of wider issues such as mistrust in the state or the medical establishment and negative experiences during the pandemic. This report is based on case study research conducted among young people (ages 12-18) in Cleveland, Ohio, US and the London borough of Ealing, UK. Whilst public discourse may label young people as ‘vaccine hesitant,’ we found that there were differences based on social location and place and this labelling may portray young people as ‘ignorant.’ We found the greatest vaccine hesitancy among older youth (15+ years old), particularly those from minoritised and deprived communities. Unvaccinated youth were also more likely to be...
Efforts to expand access to HIV care and treatment often stress the importance of disclosure of H... more Efforts to expand access to HIV care and treatment often stress the importance of disclosure of HIV status to aid adherence, social support, and continued resource mobilization. We argue that an examination of disclosure processes early in the process of seeking testing and treatment can illuminate individual decisions and motivations, offering insight into potentially improving engagement in care and adherence. We report on baseline data of early HIV disclosure and nondisclosure, including reasons for and responses to disclosure from a cohort of men and women (n=949) currently accessing antiretroviral treatment in two regions of Uganda. We found early disclosures at the time of suspicion or testing positive for HIV by men and women to be largely for the purposes of emotional support and friendship. Responses to these selected disclosures were overwhelmingly positive and supportive, including assistance in accessing treatment. Nonetheless, some negative responses of worry, fear, or social ostracism did occur. Individuals deliberately chose to not disclose their status to partners, relatives, and others in their network, for reasons of privacy or not wanting to cause worry from the other person. These data demonstrate the strategic choices that individuals make early in the course of suspicion, testing, and treatment for HIV to mobilize resources and gain emotional or material support, and similarly their decisions and ability to maintain privacy regarding their status.
Twenty-two families with one or more adult members with AIDS were extensively interviewed about s... more Twenty-two families with one or more adult members with AIDS were extensively interviewed about sociodemographic variables, knowledge of AIDS, responses to AIDS, material needs, psychological state and perception of stigma. A total of 24 individuals were enrolled. Seven subjects did not permit contact with family members. Of the 24 subjects, four denied that they have AIDS, four informed everyone in the household of the AIDS diagnosis, eight told no one at all, and eight told some of their family. Subjects reportedly did not tell their family because the family would worry, they feared rejection, it is none of their business or they wouldn't understand. Family members expressed fear of loss, shock and disbelief at the diagnosis, but did not reject the subject or fear infection. Persons with AIDS and their families expressed fear of rejection from those outside the household due to the perceived stigma associated with AIDS. The labelling of someone as having AIDS relates to their physical condition, so with declining health, subjects and their families may avoid outside contacts. A direct impact of AIDS is to diminish mobility, decreasing available economic resources. These data indicate the importance of assisting families responsible for caring for AIDS patients.
Introduction: Targeting most-at-risk individuals with HIV preventive interventions is cost-effect... more Introduction: Targeting most-at-risk individuals with HIV preventive interventions is cost-effective. We developed genderspecific indices to measure risk of HIV among sexually active individuals in Rakai, Uganda. Methods: We used multivariable Cox proportional hazards models to estimate time-to-HIV infection associated with candidate predictors. Reduced models were determined using backward selection procedures with Akaike's information criterion (AIC) as the stopping rule. Model discrimination was determined using Harrell's concordance index (c index). Model calibration was determined graphically. Nomograms were used to present the final prediction models. Results: We used samples of 7,497 women and 5,783 men. 342 new infections occurred among females (incidence 1.11/100 person years,) and 225 among the males (incidence 1.00/100 person years). The final model for men included age, education, circumcision status, number of sexual partners, genital ulcer disease symptoms, alcohol use before sex, partner in high risk employment, community type, being unaware of a partner's HIV status and community HIV prevalence. The Model's optimism-corrected c index was 69.1 percent (95% CI = 0.66, 0.73). The final women's model included age, marital status, education, number of sex partners, new sex partner, alcohol consumption by self or partner before sex, concurrent sexual partners, being employed in a high-risk occupation, having genital ulcer disease symptoms, community HIV prevalence, and perceiving oneself or partner to be exposed to HIV. The models optimism-corrected c index was 0.67 (95% CI = 0.64, 0.70). Both models were well calibrated. Conclusion: These indices were discriminative and well calibrated. This provides proof-of-concept that population-based HIV risk indices can be developed. Further research to validate these indices for other populations is needed.
Background In 2006, Uganda adopted the Reaching Every District strategy with the goal of attainin... more Background In 2006, Uganda adopted the Reaching Every District strategy with the goal of attaining at least 80% coverage for routine immunizations in every district. The development and utilization of health facility/district immunization microplans is the key to the strategy. A number of reports have shown suboptimal development and use of microplans in Uganda. This study explores factors associated with suboptimal development and use of microplans in two districts in Uganda to pinpoint challenges encountered during the microplanning process. Methods A qualitative study was conducted comparing two districts: Kapchorwa, with low immunization coverage, and Luwero with high immunization coverage. Data were collected through multilevel observation of health facilities, planning sessions and planning meetings; records review of microplans, micromaps and meeting minutes; 57 interviews with health workers at the ministry level and lower-level health facility workers. Data were analysed us...
... Clearly a focus on the economic context within which AIDS risk reduction be-haviors occur is ... more ... Clearly a focus on the economic context within which AIDS risk reduction be-haviors occur is critical (Rwabukwali et al. 1991; Schoepf 1988; Schumann et al. 1991, 1992). ... 161 Obbo, Christine African Women: Their Struggle for Economic Independence. London: Zed Press. ...
Antiretroviral treatment programs, despite biomedical emphases, require social understanding and ... more Antiretroviral treatment programs, despite biomedical emphases, require social understanding and transformations to be successful. In this paper, we draw from a qualitative study of HIV treatment seeking to examine the drug taking routines and health-related subjectivities of men and women on antiretroviral treatment (ART) at two sites in Uganda. We show that while not all participants in ART programs understand clinical protocols in biomedical terms, they adopt treatment taking strategies to integrate medication into daily practices and social spaces. In turn, these embedded practices and understandings, shape long term hopes and fears for living with HIV, including the possibility of a cure. More significant than new forms of citizenship or sociality, the authors suggest that quotidian dimensions of treatment normalization shape the long term experience of medication and outlook for the future. This article is protected by copyright. All rights reserved.
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Papers by Janet McGrath