- Child and adolescent mental health, Public Health Policy, Mental Health Disparities, Health and Human Rights, Universal Health Care, Health Disparities, and 11 moreMental Health Services Research, Immigrant and Refugee Access to Care, HIV/AIDS, Child Welfare, Mental Health, Social Policy, Poverty, Public Policy and Administration, Sociology, Discourse Analysis, and Social Workedit
- Trabajadora social. Actualmente ejerce como coordinadora y profesora del Programa Doctoral en Salud Pública con espec... moreTrabajadora social. Actualmente ejerce como coordinadora y profesora del Programa Doctoral en Salud Pública con especialidad en Determinantes Sociales de la Salud de la Escuela Graduada de Salud Pública de la Universidad de Puerto Rico. Coordinadora del Grupo de Trabajo Salud Internacional y Soberanía Sanitaria del Consejo Latinoamericano de las Ciencias Sociales. Activista en materia de derechos humanos y derecho a la salud. Sus investigaciones giran en torno al VIH en mujeres y poblaciones inmigrantes, políticas neoliberales y salud, determinantes sociales de la salud, derechos humanos y desigualdad, entre otros.edit
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La identificacion y reduccion de manifestaciones de estigma asociado al VIH/SIDA entre profesionales de la salud continua presentando retos importantes. Algunos de estos es la medicion en espacios tan complejos como los escenarios... more
La identificacion y reduccion de manifestaciones de estigma asociado al VIH/SIDA entre profesionales de la salud continua presentando retos importantes. Algunos de estos es la medicion en espacios tan complejos como los escenarios clinicos. No obstante, con el surgimiento de la tecnologia movil durante los ultimos anos, tales como telefonos inteligentes y tabletas, se potencia una mejor exploracion de las manifestaciones del estigma a traves de la investigacion y su potencial reduccion. El presente articulo tiene como objetivo reflexionar sobre la capacidad de la tableta iPad para medir las manifestaciones de estigma asociado al VIH/SIDA dentro de un escenario clinico controlado con estudiantes de medicina. El mismo esta basado en una experiencia investigativa llevada a cabo para medir manifestaciones conductuales del estigma asociado al VIH/SIDA entre estudiantes de medicina en Puerto Rico. El estudio integro el uso de iPad en la recopilacion, almacenamiento y analisis de datos. Es...
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Background Clinical trials (CT) in breast cancer have been crucial for new treatment discoveries. While participation in cancer CT is low, minorities are particularly underrepresented. This study aimed to identify factors influencing the... more
Background Clinical trials (CT) in breast cancer have been crucial for new treatment discoveries. While participation in cancer CT is low, minorities are particularly underrepresented. This study aimed to identify factors influencing the participation in CTs based on the experiences of Latina breast cancer survivors in Puerto Rico (PR), especially their CT knowledge, motivations, and concerns. Method Focus groups (FG) were conducted by two social workers and the University of Puerto Rico/MD Anderson Community Health Educator. Participants were stratified into two subgroups: a) women with CT experience and b) those without CT experience. Seven FG were completed among breast cancer survivors (n=34) at two hospitals located in Caguas and San Juan, PR. Results Our findings showed that participants expressed a basic knowledge and understanding of clinical trials. Motivations to participate included a desire to help others, non-monetary incentives to participation, self-benefits, readines...
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HIV/AIDS stigma continues affecting the provision of health services to people living with HIV/AIDS, as well as their physical and mental well-being. Scientific literature has highlighted the importance of understanding stigma... more
HIV/AIDS stigma continues affecting the provision of health services to people living with HIV/AIDS, as well as their physical and mental well-being. Scientific literature has highlighted the importance of understanding stigma manifestations that surpass one-on-one social interactions. For that reason, social research in Puerto Rico and elsewhere has highlighted the importance of understanding the Socio-Structural Factors (SSF) that foster HIV/AIDS stigma. With the objective of exploring the SSF that influence stigma manifestations related to HIV/AIDS, we conducted 9 focus groups composed by women and men on HIV/AIDS treatment that had experienced social stigma related to the disease. Participants identified SSF that they understood were related to stigma such as a) development of housing projects for people with HIV/AIDS, b) decentralization of health related services, and c) health services administrative protocols that fostered exclusion. Results evidence the importance of addres...
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To describe how a community-academic partnership between Taller Salud Inc., a community-based organization, and the Puerto Rico Community Cancer Control Outreach Program of the University of Puerto Rico was crucial in the adaptation and... more
To describe how a community-academic partnership between Taller Salud Inc., a community-based organization, and the Puerto Rico Community Cancer Control Outreach Program of the University of Puerto Rico was crucial in the adaptation and implementation of Cultivando La Salud (CLS), an evidence-based educational outreach program designed to increase breast and cervical cancer screening among Hispanic women living in Puerto Rico. This collaboration facilitated the review and adaptation of the CLS intervention to improve cultural appropriateness, relevance, and acceptability for Puerto Rican women.
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ABSTRACT This article contributes to the literature on mental health in Puerto Rico based on a focus group study with bilingual mental health service providers. The study explored perceptions of mental health and mental health services... more
ABSTRACT This article contributes to the literature on mental health in Puerto Rico based on a focus group study with bilingual mental health service providers. The study explored perceptions of mental health and mental health services and the factors that influenced utilization of mental health services. According to participants, having a mental health condition in Puerto Rico is associated with “being crazy,” a concept that carries the attitude that something wrong is going on inside the person. Stigma was identified as a powerful force influencing the perceptions of mental illness, the support of the family and community to people with mental health conditions as well as the use of mental health services. Findings suggested that the structural changes in mental health services delivery from a public to a mostly privatized system has limited quality, access and utilization of mental health services. A trend highlighted by participants was that some people seek mental health services because of socioeconomic factors. They create a factitious disorder based on economic insecurity. Mental health remains a public health concern. Suggestions included advocacy to change stigmatized perceptions, a reform that included mental health as a human right and an educational campaign that addresses prevention, early detection and treatment.
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Research Interests: Puerto Rico and Salud
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Somos Dign@s, a collective, composed by students, professors, and human rights activists, concerned about the crisis of human rights and civil liberties in Puerto Rico designed a successful national campaign for human rights known as:... more
Somos Dign@s, a collective, composed by students, professors, and human rights activists, concerned about the crisis of human rights and civil liberties in Puerto Rico designed a successful national campaign for human rights known as: "Trayecto Dignidad" or "The Journey toward Dignity." This educational campaign emulated the Freedom Riders initiative of the 1960s. Throughout this article, we discuss the participatory action research (PAR) methodology designed by Somos Dign@s which frames the work of our Trayecto Dignidad campaign. Our methodology is based on the theoretical approaches of De Sousa-Santos (2002) and his conceptualization of human rights as having to rise through a process of "Globalization from below"; that is, a process of globalization that allows oppressed classes to advocate for their human rights. Five campaigns have been implemented since 2011. Some results have shown the need: (1) to continue educating about human and civil rights;...
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Hablar sobre el costo social que tiene el carácter punitivo contra las drogas, requiere mirar la construcción socio histórica del concepto mismo y de la persona consumidora. Pero ello, también requiere de un análisis sobre aquellos... more
Hablar sobre el costo social que tiene el carácter punitivo contra las drogas, requiere mirar la construcción socio histórica del concepto mismo y de la persona consumidora. Pero ello, también requiere de un análisis sobre aquellos determinantes sociales, particularmente estructurales, que inciden en el consumo problemático de las drogas y en la violación a los derechos humanos de esa persona. Este artículo tiene el propósito de analizar las nociones del uso de drogas que se han gestado desde las diversas instancias de la sociedad y el estado, con mayor énfasis en la política de Guerra Contra las Drogas y el impacto que esto tiene en la persona consumidora. Además, se discutirá la desigualdad social como factor apremiante del fenómeno de las drogas, apartándonos de la mirada individualista y punitiva, al reconocer los determinantes sociales de la salud y el marco de los derechos humanos como importantes coordenadas para el tratamiento de personas con uso problemático de las drogas.
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This article aims to describe the manifestation of HIV stigma in the family context and how this could impact the life of people living with HIV (PLWH). The data derive from a larger phenomenological study addressing manifestations of... more
This article aims to describe the manifestation of HIV stigma in the family context and how this could impact the life of people living with HIV (PLWH). The data derive from a larger phenomenological study addressing manifestations of stigma in the lives of PLWH when interacting with the health sector. Nine focus groups were carried out in 2011 with PLWH (N=67). Eight themes emerged from the qualitative analysis. For the purpose of this article, we focus on the categories related to family dynamics: the negotiation of disclosure and non-disclosure, fear of the HIV virus and family dynamics, and life as a couple. Socio demographic information showed that 53% were between 44 to 54 years old, 80% were single, 51% were male, 42% did not complete a high school diploma, 82% were unemployed. Also, 82% described themselves as religious persons and 41% had lived with HIV for 10 years or less. Qualitative results show stigma is still present in the family context. PLWH experience fear of disc...
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HIV/AIDS stigma remains a major global health issue with detrimental consequences for people with HIV/AIDS (PWHA), especially when manifested by health professionals. Research on HIV/AIDS stigma has documented negative attitudes... more
HIV/AIDS stigma remains a major global health issue with detrimental
consequences for people with HIV/AIDS (PWHA), especially when
manifested by health professionals. Research on HIV/AIDS stigma has
documented negative attitudes towards PWHA among health
professionals. However, fewer studies have examined how HIV/AIDS
stigma is manifested behaviourally during clinical interactions and how
it interacts with other stigmas (i.e. drug use, sexism, homophobia). This
study aimed to: (1) examine behavioural manifestations of HIV/AIDS
stigma among medical students during clinical interactions, and (2)
explore HIV/AIDS stigma intersectionality with other stigmas. We
implemented an experimental design using Standardised Patient (SP)
simulations, observational techniques, and quantitative questionnaires. A
total of 237 medical students engaged in SP encounters with three
experimental scenarios: (1) PWHA infected via illegal drug use, (2) PWHA
infected via unprotected heterosexual relations, (3) PWHA infected via
unprotected homosexual relations. They also interacted with a person
with common cold (control condition). Results evidenced statistically
significant differences between the experimental and control simulation,
with higher number of stigma behaviours manifested towards
experimental conditions. Results also evidence higher HIV/AIDS stigma
towards MSM when compared to the drug user and heterosexual
woman SP’s. We discuss the implications of these findings for training of
medical students.
consequences for people with HIV/AIDS (PWHA), especially when
manifested by health professionals. Research on HIV/AIDS stigma has
documented negative attitudes towards PWHA among health
professionals. However, fewer studies have examined how HIV/AIDS
stigma is manifested behaviourally during clinical interactions and how
it interacts with other stigmas (i.e. drug use, sexism, homophobia). This
study aimed to: (1) examine behavioural manifestations of HIV/AIDS
stigma among medical students during clinical interactions, and (2)
explore HIV/AIDS stigma intersectionality with other stigmas. We
implemented an experimental design using Standardised Patient (SP)
simulations, observational techniques, and quantitative questionnaires. A
total of 237 medical students engaged in SP encounters with three
experimental scenarios: (1) PWHA infected via illegal drug use, (2) PWHA
infected via unprotected heterosexual relations, (3) PWHA infected via
unprotected homosexual relations. They also interacted with a person
with common cold (control condition). Results evidenced statistically
significant differences between the experimental and control simulation,
with higher number of stigma behaviours manifested towards
experimental conditions. Results also evidence higher HIV/AIDS stigma
towards MSM when compared to the drug user and heterosexual
woman SP’s. We discuss the implications of these findings for training of
medical students.
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HIV/AIDS stigma can have detrimental effects on physician/ patient interactions when manifested by health professionals. Unfortunately, HIV/AIDS stigma is usually manifested in an intersectional manner with other preexisting stigmas,... more
HIV/AIDS stigma can have detrimental effects on physician/
patient interactions when manifested by health professionals.
Unfortunately, HIV/AIDS stigma is usually manifested in an
intersectional manner with other preexisting stigmas, including
stigma toward men who have sex with men (MSM).
Therefore, our study aimed to examine the behavioral manifestations
of HIV/AIDS stigma among physicians in training
during simulated clinical interactions with MSM, and explore
the interrelation between HIV/AIDS stigma attitudes and
behaviors. We implemented an experimental design using
Standardized Patient simulations with a sample of 100 physicians
in training in Puerto Rico. Results show a significant difference
in the two groups’ means (p<.001), with a higher
number of stigma behaviors in the HIV MSM patient condition
(M¼6.39) than the common cold control condition (M¼5.20).
Results evidence that stigma manifestations toward MSM with
HIV may continue to be an obstacle for public health in
Puerto Rico, and that medical training to prevent stigma is still
needed.
patient interactions when manifested by health professionals.
Unfortunately, HIV/AIDS stigma is usually manifested in an
intersectional manner with other preexisting stigmas, including
stigma toward men who have sex with men (MSM).
Therefore, our study aimed to examine the behavioral manifestations
of HIV/AIDS stigma among physicians in training
during simulated clinical interactions with MSM, and explore
the interrelation between HIV/AIDS stigma attitudes and
behaviors. We implemented an experimental design using
Standardized Patient simulations with a sample of 100 physicians
in training in Puerto Rico. Results show a significant difference
in the two groups’ means (p<.001), with a higher
number of stigma behaviors in the HIV MSM patient condition
(M¼6.39) than the common cold control condition (M¼5.20).
Results evidence that stigma manifestations toward MSM with
HIV may continue to be an obstacle for public health in
Puerto Rico, and that medical training to prevent stigma is still
needed.
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RESUMEN La identificación y reducción de manifestaciones de estigma asociado al VIH/SIDA entre profesionales de la salud continúa presentando retos importantes. Algunos de estos es la medición en espacios tan complejos como los escenarios... more
RESUMEN La identificación y reducción de manifestaciones de estigma asociado al VIH/SIDA entre profesionales de la salud continúa presentando retos importantes. Algunos de estos es la medición en espacios tan complejos como los escenarios clínicos. No obstante, con el surgimiento de la tecnología móvil durante los últimos años, tales como teléfonos inteligentes y tabletas, se potencia una mejor exploración de las manifestaciones del estigma a través de la investigación y su potencial reducción. El presente artículo tiene como objetivo reflexionar sobre la capacidad de la tableta iPad para medir las manifestaciones de estigma asociado al VIH/SIDA dentro de un escenario clínico controlado con estudiantes de medicina. El mismo está basado en una experiencia investigativa llevada a cabo para medir manifestaciones conductuales del estigma asociado al VIH/SIDA entre estudiantes de medicina en Puerto Rico. El estudio integró el uso de iPad en la recopilación, almacenamiento y análisis de datos. Este artículo resalta el uso de aplicaciones (Apps) ya existentes para iPad para la implementación de instrumentos digitales para medir estigma hacia el VIH/SIDA. Al discutir la experiencia de los/as investigadores/as, se resalta el potencial del iPad y sus aplicaciones para la investigación sobre estigma. De igual forma, implicaciones sobre el uso de tecnología móvil en la investigación social son discutidas. PALABRAS CLAVE: Estigma, profesionales de la salud, tecnología móvil, VIH/SIDA. ABSTRACT The identification and reduction of manifestations of stigma associated with HIV/ AIDS among health professionals continues facing significant challenges. Some of these are the measurement of stigma in complex setting such as clinical scenarios. However, with the emergence of mobile technology in recent years, such as smartphones and tablets, possibilities for exploration and reduction of stigma manifestations are enhanced. This article aims to reflect on the ability of the iPad to help assess manifestations of stigma associated with HIV/AIDS within a controlled clinical setting with medical students. It is based on a research experience that was carried out to measure behavioral manifestations of stigma associated with HIV/AIDS among medical students in Puerto Rico. The study integrated the use of iPad in the data's collection, storage and analysis. This article highlights the use of existing applications (Apps) for iPad for the implementation of digital tools to measure stigma towards HIV/AIDS. In discussing the experience of researchers, the iPad's potential and it applications for research on stigma are highlighted. Also, implications for the use of mobile technology in social research are discussed.
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HIV/AIDS stigma continues affecting the provision of health services to people living with HIV/AIDS, as well as their physical and mental well-being. Scientific literature has highlighted the importance of understanding stigma... more
HIV/AIDS stigma continues affecting the provision of health services to people living with HIV/AIDS, as well as their physical and mental well-being. Scientific literature has highlighted the importance of understanding stigma manifestations that surpass one-on-one social interactions. For that reason, social research in Puerto Rico and elsewhere has highlighted the importance of understanding the Socio-Structural Factors (SSF) that foster HIV/AIDS stigma. With the objective of exploring the SSF that influence stigma manifestations related to HIV/AIDS, we conducted 9 focus groups composed by women and men on HIV/AIDS treatment that had experienced social stigma related to the disease. Participants identified SSF that they understood were related to stigma such as a) development of housing projects for people with HIV/AIDS, b) decentralization of health related services, and c) health services administrative protocols that fostered exclusion. Results evidence the importance of addres...
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La antología Descolonizar la Paz: Entramado de Saberes, Resistencias y Posibilidades es una publicación conmemorativa del vigésimo quinto aniversario de la Cátedra UNESCO de Educación para la Paz de la Universidad de Puerto Rico. Sus... more
La antología Descolonizar la Paz: Entramado de Saberes, Resistencias y Posibilidades es una publicación conmemorativa del vigésimo quinto aniversario de la Cátedra UNESCO de Educación para la Paz de la Universidad de Puerto Rico. Sus escritos denotan posibles caminos hacia descolonizar la paz, al romper con modelos de paz hegemónicos y proponer formas alternas de pensamiento y praxis. Proveen acercamientos a una cultura de paz positiva e integral dirigida a erradicar las manifestaciones de desigualdad, discriminación e injusticia, priorizando el aprecio por la diversidad, los derechos humanos y la sustentabilidad. Los 44 textos compilados - escritos mayormente en idioma español y algunos en inglés - reflejan las realidades históricas, políticas, socioculturales, ambientales y cotidianas de los países, pueblos y sectores representados por sus autores y autoras. El volumen se organiza alrededor de cinco ejes temáticos: (1) Educar para la paz, los derechos humanos y la sustentabilidad; (2) Sistematización reflexiva de experiencias emancipatorias de paz; (3) Construcción de paz: luchas, retos y controversias; (4) Universidad responsable: formación, investigación y acción por los derechos humanos y una cultura de paz; (5) Verano boricua 2019: resistencia y promesa. Contiene además, palabras introductorias de las editoras que describen el contenido de la antología, en el contexto del compromiso de la Cátedra UNESCO de Educación para la Paz de educar y accionar para la construcción de una cultura de paz integral y descolonizadora. Se incluye una línea del tiempo ilustrada, que documenta la trayectoria de estos primeros veinticinco años de historia de esta iniciativa universitaria pro paz.
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La antología Descolonizar la Paz: Entramado de Saberes, Resistencias y Posibilidades es una publicación conmemorativa del vigésimo quinto aniversario de la Cátedra UNESCO de Educación para la Paz de la Universidad de Puerto Rico. Sus... more
La antología Descolonizar la Paz: Entramado de Saberes, Resistencias y Posibilidades es una publicación conmemorativa del vigésimo quinto aniversario de la Cátedra UNESCO de Educación para la Paz de la Universidad de Puerto Rico. Sus escritos denotan posibles caminos hacia descolonizar la paz, al romper con modelos de paz hegemónicos y proponer formas alternas de pensamiento y praxis. Proveen acercamientos a una cultura de paz positiva e integral dirigida a erradicar las manifestaciones de desigualdad, discriminación e injusticia, priorizando el aprecio por la diversidad, los derechos humanos y la sustentabilidad. Los 44 textos compilados - escritos mayormente en idioma español y algunos en inglés - reflejan las realidades históricas, políticas, socioculturales, ambientales y cotidianas de los países, pueblos y sectores representados por sus autores y autoras. El volumen se organiza alrededor de cinco ejes temáticos: (1) Educar para la paz, los derechos humanos y la sustentabilidad; (2) Sistematización reflexiva de experiencias emancipatorias de paz; (3) Construcción de paz: luchas, retos y controversias; (4) Universidad responsable: formación, investigación y acción por los derechos humanos y una cultura de paz; (5) Verano boricua 2019: resistencia y promesa. Contiene además, palabras introductorias de las editoras que describen el contenido de la antología, en el contexto del compromiso de la Cátedra UNESCO de Educación para la Paz de educar y accionar para la construcción de una cultura de paz integral y descolonizadora. Se incluye una línea del tiempo ilustrada, que documenta la trayectoria de estos primeros veinticinco años de historia de esta iniciativa universitaria pro paz.
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La movilidad es constitutiva de la historia de la humanidad, pero las políticas imperialistas y neocolonialistas del Norte Global impuestas sobre países del Sur la convierten en prácticas de explotación, hambre, violencia y destrucción... more
La movilidad es constitutiva de la historia de la humanidad, pero las políticas imperialistas y neocolonialistas del Norte Global impuestas sobre países del Sur la convierten en prácticas de explotación, hambre, violencia y destrucción socio-ambiental. La pandemia de COVID-19 que sofoca al mundo desde finales de 2019 también ha marcado un hito en las migraciones de las Américas y el Caribe. Las prácticas migratorias de supervivencia han continuado retando el orden político hegemónico. Las luchas de las personas migrantes son la punta de lanza del otro mundo que embiste por volver a nacer –un mundo sin fronteras– y un futuro post-fronterizo (Joseph, Handerson. 2021. “Por um mundo pós-fronteiriço” MigraMundo, 23/2/2021.)