Wilson Majee

Despite progress toward UNAIDS 95-95-95 targets, HIV-related stigma continues to undermine self-management and health outcomes, particularly in rural areas. This study explored how stigma influences self-management among young people living with HIV (YPLHIV) in rural South Africa, applying a socioecological model to examine individual, social, institutional, and structural factors shaping health behaviors and cognitive functioning. Twenty interviews were conducted with YPLHIV aged 18–35 years. Data were thematically analyzed. Participants described intense internalized stigma and fear following diagnosis, often leading to shame, isolation, or suicidal ideation. Counseling, health education, and treatment success promoted self-efficacy and acceptance, enabling adherence and future-oriented goals. Family and caregiver support fostered resilience, while peer rejection reinforced stigma. Positive relationships with healthcare providers encouraged adherence, though gaps in communication around viral load and CD4 monitoring were noted. At the structural level, supportive health policies, free antiretroviral treatment, and routine testing enabled early diagnosis and treatment, but poverty and unemployment limited the ability to maintain healthy lifestyles. HIV-related stigma profoundly shapes the psychosocial well-being and self-management behaviors of YPLHIV. Interventions that strengthen self-efficacy, mental health support, and coping strategies, while simultaneously addressing family, community, and structural contexts, are essential to reduce the stigma’s impact and promote sustained engagement in care.

Around the world, rural and urban communities are addressing complex local challenges to improve wellbeing and create conditions for their residents and places to thrive. While the communities migh...

Purpose: Guided by the patient-centered care (PCC) model, this study aims to examine interpersonal aspects of care that shape African immigrants’ trust and utilization of healthcare in Florida, USA. Design/methodology/approach: In-depth interviews were conducted with 19 African immigrants aged 18 or older, living in Florida for 5 or more years and with recent experience with the US healthcare system. Interviews were audio-recorded, transcribed verbatim and analyzed using NVivo14. Findings: The thematic analysis revealed that the clash of healthcare cultures, including cultural differences between patients and providers and the lack of cultural competency among providers, hindered trust in healthcare. Discriminatory behaviors that eroded trust included mistreatment and disrespect by providers. The findings also highlighted communication problems, particularly a lack of adequate time and attention, disregard for patients’ concerns and feelings and a sense of being pushed rather than consulted, which led to distrust in healthcare among participants. Practical implications: Clinicians must be trained in communication skills and cultural humility, approaching patients as experts in their own experiences and being attentive to their values and expectations. Healthcare systems should implement structural accountability when applying PCC, including immigrant-informed patient satisfaction tools and routine equity review of service delivery. Originality/value: This study is among the few that focus on the significance of trust in shaping healthcare experiences among African immigrants, an understudied population. The authors’ analysis uniquely shows how interpersonal encounters, when misaligned with PCC ideals, serve as powerful determinants of trust.

Background: Healthcare workers are at the forefront of the global battle against COVID-19. Their vaccination perspectives, particularly in regions like Sierra Leone that have faced health crises such as the Ebola outbreak, are essential for shaping public health strategies in low-income countries that routinely face infectious disease outbreaks. Objective: This research sought to understand the perceptions and experiences of Sierra Leone’s healthcare workers concerning COVID-19 vaccination and booster doses, set against the backdrop of global health resource disparities and regional vaccine distribution challenges. Methods: Utilizing a mixed-methods approach, the study analyzed data from an online survey, which saw 1001 complete responses from 2060 participants across six Ebola-impacted districts (October–November 2022), and in-depth interviews with 24 health workers from three of these districts (February–July 2022). Results: Approximately 80% of respondents reported having received a COVID-19 vaccine, predominantly Sinopharm and AstraZeneca, yet only 34% of vaccinated participants had received a booster dose. In multivariable analyses, personally knowing someone who experienced serious COVID-19 illness or death was associated with higher odds of both initial vaccination and booster uptake (p < 0.05). By contrast, prior Ebola-related experiences were not consistently associated with vaccination outcomes. Qualitative findings contextualized these patterns, highlighting the roles of professional exposure, limited booster-related information, and inequities in vaccine availability and distribution. Conclusion: These findings indicate that vaccination strategies must move beyond initial rollout to address barriers to sustained engagement, particularly for booster uptake among healthcare workers. They also emphasize the need for equitable vaccine access and transparent, locally tailored communication to mitigate structural and informational constraints in low-income settings.

Background: Community leadership programs (CLPs) play a crucial role in cultivating local leadership that is instrumental in driving substantial changes within communities. Objective: Using an organizational commitment framework, this study evaluates the impact of two Midwestern CLPs cultivating community commitment and facilitating the application of leadership skills to promote community well‐being. Methods: A qualitative research design was employed, involving in‐depth interviews with program graduates (33), facilitators (4), and community partners (4). The study assessed the nature and effects of affective, normative, and continuance commitment developed through participation in these programs. Findings: Participants demonstrated strong community commitment, characterized by a deep emotional connection to, a felt responsibility for, and a persistent engagement with, their communities. These forms of commitment were critical in enabling participants to apply learned leadership skills effectively to initiate and sustain community improvement projects. Conclusion: CLPs are crucial in enhancing community commitment and leadership capacity, thereby driving transformative community change. The programs not only develop individual leaders but also promote a collective leadership ethos that is essential for addressing community challenges collaboratively. The findings advocate for the broader implementation of CLPs to strengthen community ties and improve collective community health and well‐being.

Covid‐19 created unprecedented disruptions on human migration. Business closures and travel bans disproportionately impacted economic migrants who were neither able to support their families nor travel to their home countries. The primary aim of the study was to explore the experiences of Malawian migrants who returned from South Africa during Covid‐19. A secondary objective was to explore solutions to the migration‐related challenges that migrants experienced. A qualitative approach involving 15 in‐depth interviews with Malawian migrants living in South Africa who returned home during Covid‐19 was used. Interviews were audio‐recorded, transcribed verbatim, and analyzed thematically. Three main themes emerged from the data and revolved around the migration stages, namely, the pre‐return/departure stage, the travel/transit phase, and the return and reintegration. Within these migration phases, participants reported failure to integrate with host community, fear of dying in a foreign country, financial hardship, corruption, risk of contracting diseases due to limited hygiene, and economic hardships in the home country as some of the main challenges they dealt with. Reintegration with family members was generally very positive as most migrants indicated that their family members were happy to see them alive. To effectively mitigate these challenges at various phases of the migration cycle, there is a need for swift and better coordination and policy change at the governmental level to take actions that support and protect migrants, as well as community and individual level actions such as saving money for emergencies.

The global health crisis precipitated by the COVID-19 pandemic underscored the necessity of swift vaccine development and distribution to curb virus transmission. However, discussions on vaccine acceptance and hesitancy have predominantly focused on pre-vaccination attitudes, often overlooking the significance of post-vaccination experiences in shaping individual and communal attitudes toward vaccines. This oversight is particularly critical among healthcare workers in low- and middle-income countries (LMICs), who play a dual role in combating the pandemic and influencing public vaccine sentiment. Using the theory of planned behavior, this study explores the post-vaccination experiences of healthcare workers in Sierra Leone and assesses how these experiences influence their attitudes toward vaccine safety, efficacy and their advocacy for vaccine uptake within their communities. Employing a qualitative design, the study interviewed 24 healthcare workers, 21 of whom were vaccinated against COVID-19. Semi-structured interviews, conducted in English or Krio, were audio recorded, transcribed verbatim and analyzed using thematic analysis to identify key themes. Three themes were identified: positive vaccination experiences exceeding initial expectations, strong belief in the vaccine’s protective benefits and active roles in vaccine advocacy. Despite initial hesitations due to concerns over potential adverse effects, participants reported no significant issues post-vaccination, fostering trust in vaccine safety and effectiveness. Healthcare workers’ positive post-vaccination experiences significantly bolster their vaccine advocacy, influencing their recommendations to patients, friends, families, colleagues and community members. This study highlights the importance of understanding and leveraging healthcare workers’ experiences to enhance public trust and vaccine uptake, crucial for pandemic response efforts in LMICs.