What makes a structural intervention? Reducing vulnerability to HIV in community settings,with particular reference to sex work

Abstract

Increasing emphasis is being placed on the need for ‘structural interventions’ (SIs) in HIV prevention internationally. There is great variation in how the concept of SI is defined and operationalised, however, and this has potentially problematic implications for their likely success. In this paper, we clarify and elucidate what constitutes a SI with particular reference to the structured distribution of power and to the role of communities. We summarise the background to the growing emphasis being placed on the concept of SIs in HIV prevention policy, and present ethnographic case-study material from a sex worker's HIV project in Kolkata, India, to illustrate the nature of HIV vulnerability and its implications for the design and targeting of successful SIs. The paper draws attention to the dual importance of (1) attending to local complexities in the micro and macro-level structures that produce vulnerability; and (2) clarifying the meaning and role of communities within SIs.     

Perioperative Nursing and Education: What the IOM Future of Nursing Report Tells Us

Changes in the current health care system have rendered the system unprepared to support new demands. Similarly, nursing education both before and after licensure is no longer adequate. Four of the eight recommendations in the Institute of Medicine’s Future of Nursing report involve changes to nursing education and pose significant goals to achieve. This makes creating innovative ways to meet the demand for educating RNs a necessity. This article discusses the Institute of Medicine’s recommendations, how they relate to perioperative nursing, and ways in which nurses and educators can help promote expectations.     

Improving interprofessional practice for vulnerable older people: gaining a better understanding of vulnerability

A key focus for professionals working with older people in the community is on those who are vulnerable, although this vulnerability is not well defined. This study sought the views of health and social care professionals and older people on vulnerability, identifying significant differences between professional and older people’s perspectives. It found that for older people, vulnerability is an emotional response to being in a specific situation, whereas for professionals, the vulnerability of those on their case loads relates to them having certain or a combination of characteristics (physical, psychological and social). The paper concludes that interprofessional care for older people in the community could be improved firstly by asking older people if they ever feel vulnerable and if so, in what situations and secondly by focusing team efforts on addressing the issues raised by older people in response to these questions.     

The Role of Occupational Therapists in Home Modification Programs at an Area Agency on Aging

The Housing Department of the Philadelphia Corporation for Aging (PCA) has administered home repair and modification programs for seniors since 1980. PCA now provides services to 1500 people annually through six programs. Currently funded at approximately four million dollars per year, PCA's Housing Department is the largest in any Area Agency on Aging.

In all these programs, PCA contracts with Occupational Therapist Consultants to assist the consumers and the programs to develop the most useful and appropriate modifications. In one program, serving Philadel-phians of all ages, PCA has recently initiated a follow-up inspection by the therapist. These inspections are not only of benefit to the particular consumer, but also yield useful information on construction specifications and on the modification process.