Papers by Patricia Stevens
Nursing Outlook, 2015
The ongoing Ebola epidemic in West Africa has drawn attention to global health inequalities, in p... more The ongoing Ebola epidemic in West Africa has drawn attention to global health inequalities, in particular the inadequacies of health care systems in sub-Saharan African countries for appropriately managing and containing infectious diseases. The purpose of this article is to examine the sociopolitical and economic conditions that created the environment for the Ebola epidemic to occur, identify challenges to and opportunities for the prevention and control of Ebola and future outbreaks, and discuss policy recommendations and priority areas for addressing the Ebola epidemic and future outbreaks in West Africa. Articles in peer-reviewed journals on health system reforms in developing countries and periodicals of international organizations were used to gather the overview reported in this article. We identify individual, structural, and community challenges that must be addressed in an effort to reduce the spread of Ebola in West Africa. The Ebola epidemic in West Africa underscores the need for the overhaul and transformation of African health care systems to build the capacity in these countries to address infectious diseases. Public-private partnerships for investment in developing countries' health care systems that involve the international community are critical in addressing the current Ebola epidemic and future outbreaks.
Research Square (Research Square), Nov 18, 2020
Background: Many LGBTQ youth experience rejection and discrimination in their families and school... more Background: Many LGBTQ youth experience rejection and discrimination in their families and schools, and the range of interventions for improving their resilience and well-being is limited. We developed and piloted an LGBT-youth-focused intervention to build resilience, called Pride Camp. Methods: Using a mixed-method approach we examined the impact of Pride Camp on resilience and other measures of well-being among LGBTQ high school students who attended camp on a college campus in 2015, 2016, and 2017. Camp attendees and the research sample included a majority proportion of transgender and gender nonbinary (TGN) youth. Results: Pre-and post-test data from our quantitative surveys (n=28), indicated signi cant increases in resilience, self-esteem, and quality of life in LGBTQ youth who attended camp. Similar results were found among the TGN participants (n=19). Qualitative data from focus groups indicated that speci cally for TGN youth, the a rming environment at the camp provided social opportunities that they had not found elsewhere. Conclusions: Findings suggest that the Pride Camp intervention provides a platform for LGBTQ youth to meet peers and engage in LGBTQ communities, improving their resilience and outlook on the future. A larger controlled study of the Pride Camp intervention is warranted.
Sexually Transmitted Infections, Sep 1, 2015
Pharmacists were mostly female (63%), and Caucasian (66%). Most were HIV-certified (68%); 31% wor... more Pharmacists were mostly female (63%), and Caucasian (66%). Most were HIV-certified (68%); 31% worked in specialty-only and 21% in traditional-only pharmacies. Majority were comfortable discussing HIV (91%), condom use (91%), and counselling PLWH who were heterosexual (96%) or MSM (97%). However, 33% were uncomfortable selling PWIDs needles and 48% teaching PWIDs to use clean needles. HIV-certified pharmacists were twice as likely to be comfortable selling PWIDs needles (OR sellneedles 2.46; p < 0.001) than condom use counselling (OR counselcondomuse 1.10; p < 0.001). Pharmacist comfort-level discussing HIV increased by 2% with age. Conclusion Our finding that a significant proportion of pharmacists were uncomfortable serving PWIDs is concerning given that pharmacists might have frequent encounters with this hard-toreach vulnerable population. Continuing professional education (CPE) curricula should be expanded to improve pharmacists' ability and comfort serving populations at high-risk for HIV.
The authors have requested that this preprint be withdrawn due to a need to make corrections.
AbstractThis paper explores the relationship between health, peace, and development by examining ... more AbstractThis paper explores the relationship between health, peace, and development by examining research focused on HIV-positive women in Malawi and Kenya. Several themes were identified including women's resiliency, women's empowerment, child-headed households, the strength of social support groups, and community involvement. Our findings indicate that these themes address five of the U.N. Millennium Development Goals (MDGs) dedicated to: eradicating extreme poverty and hunger, promoting gender equality and empowering women, reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases. Based on our findings, we recommend the development and support of policies that build upon women's existing social networks and capacities as a way of enhancing women's empowerment in an effort to meet the MDGs. Also of key importance is the need to improve the livelihoods of the millions of orphans in Eastern and Southern Africa, as this h...
Nursing Inquiry, 2018
Cultural diversity courses have been introduced to nursing curricula, particularly in the United ... more Cultural diversity courses have been introduced to nursing curricula, particularly in the United States, in an effort to promote cultural safety and as a way of helping to improve health outcomes for diverse populations . There is limited literature, however, on how these courses can be tailored to enhance effective learning that will contribute toward a greater understanding among future professional nurses about the unique health needs of various populations in an effort to improve disparate health outcomes. The purpose of this descriptive qualitative study was to gain insight into undergraduate students' worldviews about people who differ from themselves in the context of a college course about cultural diversity, which emphasizes cultural safety. Specifically, we sought to understand what values students gained from documentaries watched in this course, and how the course content was helpful in changing student perceptions. The study involved a convenience sample of pre-clinical nursing students enrolled in a cultural diversity course at two closely affiliated academic institutions in the same University System. Following the viewing of a documentary each week in class, students submitted their reactions. These
Journal of professional nursing : official journal of the American Association of Colleges of Nursing
This descriptive, qualitative study was conducted to gain insight into how pre-clinical nursing s... more This descriptive, qualitative study was conducted to gain insight into how pre-clinical nursing students' worldviews about people different from themselves are formed, changed, and expanded. 90 mid-term and 87 end- of-term reflection papers in a cultural diversity course were analyzed. Krathwohl's taxonomy of learning guided the evaluation of students' development. Our findings showed that the course content supported most students' in their affective development. It was also evident that students' perspectives, which were influenced by past experiences, changed as the course progressed. However, while a positive change in perspective towards providing culturally safe care was evident, this was not the case for all students. Our findings have implications for informing the development of undergraduate nursing courses that prepare future nurses for their professional role in providing culturally safe care.
Transgender health, 2017
Purpose: In this study, we explored experiences and feelings of safety in public facilities in re... more Purpose: In this study, we explored experiences and feelings of safety in public facilities in relation to psychological well-being among transgender and gender nonconforming (TGNC) youth in the Midwest in the summer of 2016, in the context of ongoing legislative proposals and regulations regarding school and public bathroom use in the United States. Methods: We used a mixed-method approach, with (1) a self-administered, paper-and-pencil survey of 120 TGNC youth, focusing on differences of self-esteem, resilience, quality of life (QoL), perceived stigma, feelings of safety, and experiences of public facility use and (2) two focus group interviews (n=9) in which TGNC youth discussed individual perceptions, attitudes, and experiences of bathroom use outside participants' homes. The samples consisted predominantly of individuals assigned female at birth and currently of trans-masculine identity. Results: TGNC youth in our sample who reported that they had felt unsafe in bathrooms d...
Journal of Interpersonal Violence, 2016
In Malawi, 41% of women aged 15 to 49 report ever experiencing intimate partner violence (IPV). A... more In Malawi, 41% of women aged 15 to 49 report ever experiencing intimate partner violence (IPV). Although there is evidence of the pervasiveness of IPV in Malawian society, the context in which it occurs and how women respond is not well described. The purpose of this study was to describe experiences of IPV of rural Malawian women. In-depth interviews were conducted with 55 rural Malawian women aged 21 to 75 years ( M = 39) as part of a larger, mixed-methods study. This qualitative thematic analysis highlights husbands’ IPV against wives and women’s actions to protect themselves and their children, and to thrive despite the violence. Our use of a postcolonial feminist perspective led us to acknowledge Malawian women’s acts of resistance in the midst of the harsh realities of IPV and gender inequality. We contend women’s resilience and resistance against oppression within intimate relationships are critical tools in the process of reducing IPV. Structural interventions that (a) addre...
AIDS and Behavior, 2016
The objective of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4-Health) ... more The objective of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4-Health) study was to evaluate the impact of a large-scale multi-level economic and food security intervention on health outcomes and HIV vulnerability in rural Malawi. The study employed a quasi-experimental non-equivalent control group design to compare intervention participants (n = 598) with people participating in unrelated programs in distinct but similar geographical areas (control, n = 301). We conducted participant interviews at baseline, 18-, and 36-months on HIV vulnerability and related health outcomes, food security, and economic vulnerability. Randomly selected households (n = 1002) were interviewed in the intervention and control areas at baseline and 36 months. Compared to the control group, the intervention led to increased HIV testing (OR 1.90; 95 % CI 1.29-2.78) and HIV case finding (OR = 2.13; 95 % CI 1.07-4.22); decreased food insecurity (OR = 0.74; 95 % CI 0.63-0.87), increased nutritional diversity, and improved economic resilience to shocks. Most effects were sustained over a 3-year period. Further, no significant differences in change were found over the 3-year study period on surveys of randomly selected households in the intervention and control areas. Although there were general trends toward improvement in the study area, only intervention participants' outcomes were significantly better.
Background: Social support is a key resource within African American communities and it has been ... more Background: Social support is a key resource within African American communities and it has been associated with better physical and mental health outcomes among HIV-positive people. However, researchers have not adequately explored how social support functions among HIV-positive African Americans. We believe that a more nuanced understanding of the relationship between HIV-related problems, support resources, and relational functioning is imperative in order to develop effective interventions within HIV-affected African American communities. Methods: Thirty-four HIV-infected (i.e., seroconcordant) dyads completed psychosocial questionnaires and a communication task. Using the actor-partner interdependence model, we analyzed dyadic data to determine whether there were actor and/or partner effects within dyadic relationships on measures of support and conflict and HIV-related problems, communication about these problems, and health symptoms. Results: As predicted, we found significan...
Background: Malawi's maternal mortality rate is among the highest in the world. Improving chi... more Background: Malawi's maternal mortality rate is among the highest in the world. Improving childbirth safety in resource-limited countries requires innovative structural interventions. Methods: Within a 5-year, mixed-methods, quasi-experimental study in rural central Malawi, we investigated how Village Savings and Loan Associations (VSLA) affected birth practices. We purposively sampled VSLA members (60 women / 30 men) for 90 in-depth interviews and 9 focus groups analyzed thematically. Results: Participation in VSLA mobilized individuals to improve childbirth safety in tangible ways. Loans obtained early purchased transport to antenatal visits and supplies for hospital births. Ahead of labor, women and accompanying female family members traveled to faraway health care facilities and camped there for days or weeks until delivery. VSLA cash secured care for children left at home, and covered costs of residing at hospital. Many women still delivered at home, however, when they coul...
Background: Malawi has struggled with widespread food insecurity and associated health problems f... more Background: Malawi has struggled with widespread food insecurity and associated health problems for years due to drought, depleted soil, decreased food diversity, and poverty. Sustainable agriculture may offer a solution by diversifying the range of foods grown and rehabilitating soils, resulting in more stable food supplies and better nutrition. Methods: As part of a larger study, we conducted a random household survey (N=1001) in the Kasungu district of central Malawi, and assessed food security and use of a variety of sustainable agriculture techniques. Results: 762 households (76%) experienced at least one month of food insecurity in the past year (Median = 3 months); 239 households (24%) reported being food secure. Food secure households were more likely to use vetiver grass (for erosion management) (23% vs 13%, p Conclusions: Use of sustainable agriculture methods was associated with food security among smallholder agriculturalists in Malawi. Interventions to increase the use ...
Background: We are evaluating an economic intervention combining Village Savings and Loan Associa... more Background: We are evaluating an economic intervention combining Village Savings and Loan Associations (VSLA) and agricultural training to determine its impact on childbirth practices in Malawi, where maternal mortality is extremely high. Methods: In this five-year, mixed-methods quasi-experimental study, we are examining birth practices and barriers to delivery services in 900 households in rural central Malawi; 600 in the intervention area, 300 in the control area. Baseline and 18 month follow-up surveys were completed. Results: Eighteen months into the intervention, differences in birth practices between the intervention and control areas were not observed, although trends in both indicate movement toward institution-based births. Between baseline and follow-up, intervention households (101 births) and control households (50 births) delivered fewer babies at home (Intervention: 8.8% decrease, p=0.10; Control: 17.5% decrease; p=0.02); only change in control households was signific...
SAGE Open, 2014
The number of older women living with HIV in Kenya is increasing. However, there are little empir... more The number of older women living with HIV in Kenya is increasing. However, there are little empirical data available about their role in HIV prevention. The purpose of this study was to understand the nuanced role of older women in HIV prevention. We engaged 54 HIV-positive women in three narrative-eliciting interviews between 2009 and 2010 over a period of 6 months to understand their role in HIV prevention. In this article, we focus on a sample subset of 7 rural women 50 years and older living with HIV. From narrative analysis of 19 interviews from 7 women who were 50 years and older, four themes emerged: promoting HIV transmission risk reduction, promoting HIV testing, educating others about HIV, and protecting children from HIV infection. HIV-positive older women are engaged in helping mitigate HIV in their communities and should be central to meaningful HIV-related interventions especially in rural communities
SpringerPlus, 2014
Background: Poverty and lack of a predictable, stable source of food are two fundamental determin... more Background: Poverty and lack of a predictable, stable source of food are two fundamental determinants of ill health, including HIV/AIDS. Conversely, episodes of poor health and death from HIV can disrupt the ability to maintain economic stability in affected households, especially those that rely on subsistence farming. However, little empirical research has examined if, and how, improvements in people's economic status and food security translate into changes in HIV vulnerability. Methods: In this paper, we describe in detail the methods and protocol of an academic-NGO collaboration on a quasi-experimental, longitudinal study of the mechanisms and magnitude of the impact of a multilevel economic and food security program (Support to Able-Bodied Vulnerable Groups to Achieve Food Security; SAFE), as implemented by CARE. Primary outcomes include HIV vulnerability (i.e., HIV risk behaviors, HIV infection), economic status (i.e., income, household assets) and food security (including anthropometric measures). We recruited participants from two types of areas of rural central Malawi: traditional authorities (TA) selected by CARE to receive the SAFE program (intervention group) and TAs receiving other unrelated CARE programming (controls). In the intervention TAs, we recruited 598 program participants (398 women, 200 men) and interviewed them at baseline and 18-and 36-month follow-ups; we interviewed 301 control households. In addition, we conducted random surveys (n = 1002) in the intervention and control areas with a 36-month assessment interval, prior to and after implementation of SAFE. Thus, we are examining intervention outcomes both in direct SAFE program participants and their larger communities. We are using multilevel modeling to examine mediators and moderators of the effects of SAFE on HIV outcomes at the individual and community levels and determine the ways in which changes in HIV outcomes feed back into economic outcomes and food security at later interviews. Finally, we are conducting a qualitative end-of-program evaluation consisting of in-depth interviews with 90 SAFE participants. Discussion: In addition to examining pathways linking structural factors to HIV vulnerability, this research will yield important information for understanding the impact of a multilevel environmental/structural intervention on HIV, with the potential for other sustainable long-term public health benefits.
Violence Against Women, 2013
In this critical ethnography, 72 HIV-infected women in Southern Malawi participated in 12 focus g... more In this critical ethnography, 72 HIV-infected women in Southern Malawi participated in 12 focus groups discussing the impact of HIV and violence. Our analysis, informed by a postcolonial feminist perspective, revealed women’s capacity to collectively engage in safety planning. We present our findings about women’s experiences based on narratives detailing how women collectively strategized safety planning efforts to mitigate the impact of violence. This study helps to fill a gap in the literature on the intersection between HIV and violence in women’s lives. Strategies discussed by the women could form a basis for safety planning interventions for women in similar circumstances.
Journal of Community Genetics, 2013
There is limited information about what African Americans think about biobanks and the ethical qu... more There is limited information about what African Americans think about biobanks and the ethical questions surrounding them. Likewise, there is a gap in capacity to successfully enroll African Americans as biobank donors. The purposes of this community-based participatory study were to: (a) explore African Americans' perspectives on genetics/genomic research, (b) understand facilitators and barriers to participation in such studies, and (c) enlist their ideas about how to attract and sustain engagement of African Americans in genetics initiatives. As the first phase in a mixed methods study, we conducted four focus groups with 21 African American community leaders in one US Midwest city. The sample consisted of executive directors of community organizations and prominent community activists. Data were analyzed thematically. Skepticism about biomedical research and lack of trust characterized discussions about biomedical research and biobanks. The Tuskegee Untreated Syphilis Study and the Henrietta Lacks case influenced their desire to protect their community from harm and exploitation. Connections between genetics and family history made genetics/genomics research personal, pitting intrusion into private affairs against solutions. Participants also expressed concerns about ethical issues involved in genomics research, calling attention to how research had previously been conducted in their community. Participants hoped personalized medicine might bring health benefits to their people and proposed African American communities have a "seat at the table." They called for basic respect, authentic collaboration, bidirectional education, transparency and prerogative, and meaningful benefits and remuneration. Key to building trust and overcoming African Americans' trepidation and resistance to participation in biobanks are early and persistent engagement with the community, partnerships with community stakeholders to map research priorities, ethical conduct of research, and a guarantee of equitable distribution of benefits from genomics discoveries.
American Journal of Public Health, 2007
We investigated the sexual behaviors of 55 HIV-infected women in Wisconsin who narrated their liv... more We investigated the sexual behaviors of 55 HIV-infected women in Wisconsin who narrated their lives in 10 interviews over 2 years during 2000 to 2003. We sought to examine the interpersonal situations in which sexual risk occurred. During the prospective period, 58% (32) were abstinent and 24% (13) practiced safe sex exclusively. The remaining 18% (10) engaged in unprotected sexual intercourse, but only in primary partnerships, almost all of which were with serodiscordant partners. We focused on experiential detail and narrative depth of 10 women who had sex without condoms. These narratives demonstrate how the women attempted to initiate condom use but engaged in unprotected sexual intercourse regularly at the insistence of their partners. Consequently, these women lived in trepidation of causing their partners’ sickness and death.
AIDS and Behavior, 2009
In their article, Microfinance and HIV/AIDS prevention: Assessing its promise and limitations, Dw... more In their article, Microfinance and HIV/AIDS prevention: Assessing its promise and limitations, Dworkin and Blankenship (2009) provide a valuable introduction to microfinance as a structural HIV prevention approach and highlight its significance and limitations for women’s economic empowerment. Their overview of the components and types of microfinance programs is excellent. Their emphasis on the challenge to gender norms posed by woman-only projects is well taken. Gender power issues should clearly be integrated into future microfinance studies. Most importantly, their analysis contributes to a growing literature calling for HIV prevention efforts targeted to distal determinants of risk. In this commentary, we respond to Dworkin and Blankenship (2009) about the limitations of microfinance used as a stand-alone strategy for HIV prevention, and advocate expanding the literature consulted in planning research on interventions, such as microfinance, targeting structural and contextual factors. We expand on their point about the methods most appropriate for studying microfinance and other structural interventions, suggesting that study designs beyond the randomized controlled trial (RCT) can provide compelling evidence of the success of these types of interventions and in many cases are more appropriate than the RCT. We conclude by providing an applied example, describing our ongoing investigation of a large mutli-level intervention involving microfinance and food security elements, being conducted in collaboration with an international poverty relief organization. For decades, the vast majority of HIV/AIDS prevention studies have focused on individual behavioral intervention effects on HIV-related outcomes and, to a much smaller extent, on the impact of structural and multi-level interventions. Sexual risk has often been the exclusive target of change. The efficacy of interventions tested in RCT has not consistently translated well to large-scale public health programs, often producing only marginal risk reduction that is difficult to sustain (Coates et al. 2008). It can be reasonably argued that problems in translation are due to imperfect implementation in the field, adaptation that departs from core intervention elements, or insufficient public health spending to allow widespread implementation of successful interventions. It is also likely that empirically supported individually-oriented intervention approaches would have larger and longer lasting effects in practice if recipients were not faced with myriad complicating factors due to their social and environmental context. Interventions tackling structural determinants of HIV vulnerability, including poverty, food insecurity, and gender power inequities, may provide the improvement in context that allows more proximally-focused intervention L. S. Weinhardt (&) Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, 2071 N Summit Ave, Milwaukee, WI 53211, USA e-mail: [email protected]
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Papers by Patricia Stevens