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No HIV-Positive MSM in Screening

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                    [post_content] => Djamil Bangoura, president of Association Prudence, Senegal’s largest LGBT health and human rights advocacy group, lists HIV prevention and treatment for men who have sex with men (MSM) as one of the organization’s most urgent priorities. Even though systematic homophobia in Senegal limits the organization's ability to improve health outcomes for the LGBT community, Prudence organizes HIV testing for MSM by using its network of 500 members.

“We need to be careful, but not so careful that we can’t take action on the ground,” Bangoura said. “We’re careful, but we take actions for key populations. We target the community in which we are a part of, the LGBT population.”

Prudence connects key populations to LGBT-friendly health services for testing and helps to refer HIV-positive MSM for treatment.

“We’re here as an organization to sensitize and to organize testing zones, and if we test one of our brothers who is positive, we try to counsel him so that he knows it’s not the end of the world,” Bangoura said. “He can live like everybody.”

Amadou, a member of Prudence, took part in a recent HIV testing and sensitization campaign with key populations in Dakar. Prudence frequently hosts these screenings for the LGBT community.

“By the grace of God, we had zero cases, and that’s a victory for us as the LGBT community to know that people took precaution against this disease,” Amadou said.

Although he explains that no men tested positive for HIV during this one screening, the HIV prevalence is 44% among Senegalese MSM 25-years and younger and 38% among MSM 25-years and older.
“We’re here as an organization to sensitize and to organize testing zones, and if we test one of our brothers who is positive, we try to counsel him so that he knows it’s not the end of the world,” Bangoura said. “He can live like everybody.”  
The Joint United Nations Programme on HIV/AIDS (UNAIDS) Key Populations Atlas, a new visualization tool, allows users to navigate country-specific data on populations particularly vulnerable to HIV. These key populations include sex workers, people who inject drugs, transgender people, prisoners, and MSM. UNAIDS maps eight indicators of key population health in countries where data sources are available. These indicators estimate HIV prevalence, population size estimate, condom use, HIV testing rates, ART coverage, denied health services, a measure of fear of seeking health services, and health laws. msm_senegal_chart_sm Because UNAIDS estimates the HIV prevalence at 0.5% in the Senegalese general population, these data reveal disparities in HIV rates in the country. “We went to battle,” Amadou said. “We fight, but I don’t think from now until 2020 we’ll have what we want. We hope with all our heart, but we can say that we’re truly vulnerable.” The UNAIDS Key Populations Atlas indicates 72.6% of Senegalese MSM use condoms and 41.9% are tested for HIV. Notably, the average HIV prevalence among MSM was 18.5% in 2013 and 41.9% in 2014 and 2015, though it ranges depending on age. Bangoura worries for MSM who are not tested for HIV and for those who are not included in UNAIDS estimates. He knows the stories of men who flee Senegal seeking refuge abroad in countries like Morocco and Mauritania. “We realized there have been a lot of loss of life,” Bangoura said. “There are a lot of displacements.” This is part four in a Public Health Post series about LGBT health in Senegal. Click here to read parts one, two, and three. The informants’ names are changed to protect their safety. Interviews were conducted in French and translated to English. Featured Image: An HIV/AIDS message on the exterior wall around a hospital in the Casamance regional capital of Ziguinchor, Senegal. © 2006 Sara A. Holtz, Courtesy of Photoshare [post_title] => No HIV-Positive MSM in Screening [post_excerpt] => In part four of PHP's series on LGBT health in Senegal, Association Prudence connects key populations to LGBT-friendly health services for testing and helps to refer HIV-positive MSM for treatment. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => high-prevalence-no-hiv-positive-msm-screening [to_ping] => [pinged] => [post_modified] => 2017-08-26 23:38:15 [post_modified_gmt] => 2017-08-27 03:38:15 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_viewpoint&p=739 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

In part four of PHP’s series on LGBT health in Senegal, Association Prudence connects key populations to LGBT-friendly health services for testing and helps to refer HIV-positive MSM for treatment.

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You Are Where You Live

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                    [post_content] => “You are where you live.”  This variation on the old saying is meant to highlight that where you spend your daily life influences your opportunities for healthy living. In light of the many environmental issues surrounding the Flint Water Crisis, and as the world of public health wades deeper into the waters of geographical inquiry, this concept bears extra weight.

Indeed, my involvement in the Flint Water Crisis began because of a lack of analytical and spatial sense about ‘YAWYL’ on the part of state-level officials. As I’ve noted elsewhere, some officials’ eyes were blind to the blood lead issue because of their use of an inappropriate unit of analysis, which led to a partial occlusion of the problem. Our team’s ability to discern the need for better analysis helped bring the state to its knee—though we should have never had to intervene.

A firm grounding in geographical concepts is particularly important for understanding not only what happened in Flint, but specifically where it happened and why it happened there.

In Flint, health disparities exist at multiple geographic levels—not only when compared to other regions, but also when comparing one neighborhood to another—and inquiry must therefore be nested within these contexts. Flint is not unusual in this regard. But like other cities with internal health equity issues, Flint is often maligned in the media because of the many social causes and manifestations of these disparities. Many people are unable to see why things are as they are, and instead focus on the outcomes as the core problem.

We have established that [ictt-tweet-inline]City of Flint residents were disproportionately affected by lead leaching into their drinking water[/ictt-tweet-inline]. But their challenges are much broader than lead in water and include all aspects of daily life.

City residents face the decision of sending their children to a struggling public school system or taking extra effort to send them out of district. When compared to the surrounding county, residents in the city have heightened exposure to crime and blight, and diminished opportunities for finding healthy foods or other retail goods. Flint residents also pay higher water rates (in fact, the highest in the country), higher property taxes, and receive poorer public services in return. These problems did not happen overnight; their causes date back decades.

In geographic research, such variables can be pulled together to contextualize what has been referred to as ‘deprivation amplification,’ or the negatively synergistic burden experienced by living in such environments. The role of GIS is essential, because it allows the user to understand spatial clustering and distribution of phenomena above and beyond census estimates of socioeconomic characteristics.
...the state’s actions over the past few decades are akin to a conversation like the following: “Give me your wallet…great, now buy us lunch. What do you mean you can’t afford it? Let’s go to a payday loan facility so you can afford it.”  
Subsequent work done by the Hurley/MSU collaborative team along these lines has recently shown that residence time of water in pipes, house age, and neighborhood housing condition are all strongly correlated to those sites where blood lead levels were highest in the immediate aftermath of the water source switch. It implicates a declining infrastructure in the public health problem. That is, [ictt-tweet-inline]the problem is one of neglect by a departing population and a tendency to abandon our cities[/ictt-tweet-inline]. It also reflects on the state of Michigan’s anti-urban bias over many decades.  Following annexation attempts by central cities in the 1960s and 1970s, the suburb-friendly state legislature passed laws establishing the right of suburbs to remain separate. More recently, the state has greatly reduced revenue sharing to core areas, and established a draconian emergency manager law that removes democratic control from local governments, allows the state to unilaterally cut expenses, and which has a stipulation preventing the public from conducting a referendum on the law. To paraphrase our State Senator Jim Ananich at a recent Save MI City event sponsored by the Michigan Municipal League, the state’s actions over the past few decades are akin to a conversation like the following: “Give me your wallet…great, now buy us lunch. What do you mean you can’t afford it?  Let’s go to a payday loan facility so you can afford it.” Such thinking lacks any form of logic, effectively blaming and then punishing the victim for an undeserved assignment of culpability. In this context, it is important for public health and healthcare providers to understand not only the singular context of lead-in-water, but the myriad determinants that roll together to affect health. All of these elements require an appreciation of the influence not only of the existing built environment on health, but of the structural forces that dictate how our cities will rise or fall. [ictt-tweet-inline]Flint must be viewed in the context in which it was placed: one in which the state set it up to fail[/ictt-tweet-inline]. Culpability should not be misdirected—decades of state policies created the conditions by which such a catastrophe would happen. Image: Michael Kappel, Flint MI Childrens Museum 366, used under CC BY/cropped from original  [post_title] => You Are Where You Live [post_excerpt] => Geographical concepts are important for understanding not only what happened in Flint, but specifically where it happened and why it happened there. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => you-are-where-you-live [to_ping] => [pinged] => [post_modified] => 2017-08-26 23:35:13 [post_modified_gmt] => 2017-08-27 03:35:13 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_viewpoint&p=732 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Geographical concepts are important for understanding not only what happened in Flint, but specifically where it happened and why it happened there.

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Campaigns Offer a Healthy Way Out for Senegalese MSM   

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                    [post_content] => For Senegalese men who have sex with men (MSM), discovering LGBT-friendly health providers is as challenging as finding housing, securing employment, and coming out. One non-governmental organization is making it easier for vulnerable Senegalese to access health care. The organization – referred to here as NGO – engages key populations facing discrimination because of their social status and operates in two of Dakar’s neighborhoods.

The NGO partners with the National Network of Key Population Associations to assist Senegalese MSM via three education campaigns. Two campaigns emphasize sexual and reproductive health and harm reduction by partnering MSM with 13 local clinics. A third campaign, implemented in 2016, aims to reduce provider discrimination against LGBT Senegalese.

“We think that it’s a problem of stigma because he who is stigmatized, who is discriminated, he lives in hiding,” said an NGO representative managing the campaigns. “There are those who are watching his every move, so he’s scared to go to the hospital. He’s scared to go to the clinic.”

In 2015, Amadou joined Association Prudence, Senegal’s largest LGBT health and human rights advocacy group. He realizes how [ictt-tweet-inline]homophobia among health providers is a barrier to MSM accessing health care[/ictt-tweet-inline].

“They don’t have the understanding to accept MSM or lesbians to treat us,” Amadou said. “In Senegal, people say that MSM are troublemakers, so they don’t touch us. They don’t see us. They don’t greet us. It wouldn’t be normal for them to treat us.”

Issa recently joined Prudence. He hides his sexuality from his father and also refuses to disclose his sexual orientation to health providers. Outing himself to friends, family, or health providers could lead to violence against MSM.

“When gays have sexually transmitted infections, we’re scared to go to the hospital for treatment,” Issa said. “There are even some hospitals that turn away from gays. When I go to the doctor, I never tell him that I’m gay.”

A disproportionate number of Senegalese MSM suffer from HIV: the prevalence ranges between 38-44% in this key population, but affects less than 1% of the general population in Senegal. Prudence refers HIV-positive MSM to LGBT-friendly health providers, although LGBT-friendly health providers, too, have to closet themselves when delivering services to Senegalese MSM. Although LGBT-friendly health providers are few and far, Lamine used Prudence to find a safe clinic.

“I always want to know my health [status],” Lamine said. “Every three months, I go for testing to also control my health.”

Recently, Amadou represented Prudence at a community discussion in Dakar. The conference fostered a dialogue on HIV/AIDS prevention between key populations, politicians, and religious leaders.
“They don’t have the understanding to accept MSM or lesbians to treat us,” Amadou said. “In Senegal, people say that MSM are troublemakers, so they don’t touch us. They don’t see us. They don’t greet us. It wouldn’t be normal for them to treat us.”  
“They told us that it’s the LGBT community who is responsible for the AIDS virus spreading throughout Senegal,” Amadou said. “Can you believe that? As if it’s only us who have sexual relationships.” During the focus group discussions with community stakeholders, he underscored the LGBT community’s role in HIV prevention. Amadou sees how the partnership between Prudence, the NGO, and LGBT-friendly health providers revolutionizes care for the vulnerable because it includes members of the Senegalese LGBT community in service delivery. “I know that not everybody is MSM, but the majority of people fighting this virus are MSM,” Amadou said. As a part of the third education campaign, the NGO plans to organize a community discussion similar to the conference Amadou attended with Prudence. “We’re organizing debates with the community that are composed of religious leaders and doctors,” the NGO representative said. “I think that it’s important because if these leaders are informed, then they’ll return and inform everyone else.” The education campaigns help foster a dialogue around the need for LGBT-friendly health providers by engaging MSM and community leaders in Senegal. “We try to work with these key populations so that they can live their sexual orientation without being an object of stigma, discrimination, and persecution because there are those who are persecuted,” the NGO representative said. Cheikh, another member of Prudence, was beaten by onlookers after attending a friend’s birthday party in Pikine. The police outed him to his family, and he fears seeking health services because of the stigma associated with identifying as MSM. “We need everything,” Cheikh said. “We need to live like everyone else. When everyone else is sick and they go to the hospital, they’re treated like Senegalese citizens. Here, we’re not.” Editor’s note – The NGO is unidentified and the informants’ names are changed to protect their safety.   Interviews were conducted in French and translated to English. This is part three in a series about LGBT health in Senegal. Click here for parts onetwo and four. Image: HPIM1525 by Xavier Damman, used under CC BY/cropped from original [post_title] => Campaigns Offer a Healthy Way Out for Senegalese MSM    [post_excerpt] => In part three of PHP's series on LGBT health in Senegal, an NGO assists Senegalese MSM via three education campaigns that emphasize sexual and reproductive health and harm reduction. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => campaigns-offer-healthy-way-msm [to_ping] => [pinged] => [post_modified] => 2018-02-22 12:10:33 [post_modified_gmt] => 2018-02-22 17:10:33 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_viewpoint&p=736 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

In part three of PHP’s series on LGBT health in Senegal, an NGO assists Senegalese MSM via three education campaigns that emphasize sexual and reproductive health and harm reduction.

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Viewpoint

The End of “The End of AIDS”

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                    [post_content] => In late 2014, the organizers of the International AIDS Conference (IAC), the world’s largest meeting on any global health topic, met with a small group of scientists, activists, and policymakers to begin assembling that meetings’ return to South Africa. The last IAC in South Africa was held fourteen years earlier at a very different time in the AIDS response.

In 2000, the IAC arrived in Durban accompanied by a train of anger and controversy. Nearly two decades into the global pandemic, there were only ad hoc efforts by world governments to address the explosion of HIV infections and deaths in the developing world. In South Africa, President Thabo Mbeki’s misinformed, anti-science public health policies created a blockade against life-saving HIV treatment. His administration’s misguided attempts to attribute the role inequality and poverty play in fueling the epidemic cost thousands of lives before the conference arrived (and, by some estimates, hundreds of thousands more before those policies were rescinded).

The advocates and researchers gathered at the 2000 AIDS Conference were outraged by what they perceived as indifference to catastrophe. The conference became a lens through which the world saw the stark inequality in fighting HIV. Public demonstrations and pleas for change dominated. Though it is hard to pinpoint one moment, Nelson Mandela’s personal, human appeal to delegates at the closing ceremony exemplified how the world shifted – from shock and inaction to moral responsibility and ownership. In the months following the conference, the world began building a massive public health infrastructure to stop AIDS. Today, it is the largest public health response to a global pandemic in history.
The debate in Johannesburg in 2014 was not about the scientific reality of ending AIDS or the mathematical models showing the within-arms-reach-of-target possibilities. All were in agreement that these are very real scenarios. The argument was about our inability to address two persistent challenges to the “end of AIDS” goal.  
But for many in that meeting in Johannesburg in 2014, progress since AIDS 2000 felt mixed. A debate about the theme and direction of AIDS 2016 spiraled into a larger conversation about the separation between global advocacy and lived reality. The Conference’s South African hosts and partners made clear that language about “the end of AIDS” was unacceptable, an insult to the efforts involved in mounting the world’s largest AIDS response. The oversimplification of an enormous goal, some felt, was setting unrealistic expectations around how soon the world could move beyond AIDS (and setting up blame for not achieving it). This was not simply a matter of semantics. For many years, the “end of AIDS” was a rallying cry for global advocates eager to summarize the rapid rate of scientific breakthrough in fighting AIDS and the tremendously successful effort to rapidly scale up HIV treatment. In as little as ten years, scientists discovered the power of voluntary medical male circumcision to reduce HIV infection, the role viral suppression plays in preventing HIV transmission, and the utility of some forms of HIV treatment as both a therapeutic and prophylactic intervention. The pace of discovery was so rapid and the promise so extreme that the Economist touted the possibility of ending AIDS on its front cover in June 2011. The debate in Johannesburg in 2014 was not about the scientific reality of ending AIDS or the mathematical models showing the within-arms-reach-of-target possibilities. All were in agreement that these are very real scenarios. [ictt-tweet-inline]The argument was about our inability to address two persistent challenges to the “end of AIDS” goal[/ictt-tweet-inline]. The first is the significant lag between scientific discovery and on-the-ground implementation. Realizing the gains of new science has always been a gradual process, but that has felt particularly pronounced for HIV, as in the case of voluntary medical male circumcision. Similarly, it has been four years since the FDA approved Truvada as pre-exposure prophylaxis to reduce the risk of sexually-acquired HIV infection and yet only 20 countries have begun to implement it. The second is the persistent role stigma, discrimination, and inequality play in fueling HIV transmission everywhere. Travel bans, HIV criminalization, marginalization of key populations, and gender inequality continue to determine vulnerability to HIV. [ictt-tweet-inline]HIV has always fed off of our discomfort talking about sex or respecting diversity, and it continues to do so[/ictt-tweet-inline]. Now, more than five months after the conference, it is easy to see how important the debate on “the end of AIDS” was to the content and impact of AIDS 2016.  In the end, we chose a theme that described a more immediate agenda for many around the table – Access, Equity, Rights Now. This infused much of the conversation that followed, including a pragmatic reassessment of our progress on HIV prevention and treatment as well as a hopefulness that we haven’t lost the fire and spirit that carried us this far. A conference won’t end an epidemic, but it can be an important tool for critically reassessing if our goals are aligned with our actions. As we look to AIDS 2018 in Amsterdam, we begin that process again. Featured Image: UNIS ViennaWorld AIDS Day 2014, UNODC marked World Aids Day by projecting giant AIDS Ribbon on UN building, used under CC BY NC-ND 2.0 [post_title] => The End of “The End of AIDS” [post_excerpt] => Two persistent challenges remain to the “end of AIDS” goal. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => end-end-aids [to_ping] => [pinged] => [post_modified] => 2017-11-29 14:00:13 [post_modified_gmt] => 2017-11-29 19:00:13 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_viewpoint&p=678 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Two persistent challenges remain to the “end of AIDS” goal.

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ACA Politics: Lessons from Kentucky

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                    [post_content] => I’m the former Governor of Kentucky, the state that most aggressively embraced and succeeded in implementing the Affordable Care Act as a core part of a holistic strategy to improve its collective health. It’s also the state that for the past year has been watching my Republican successor starting to dismantle that strategy for no reason other than he can. So I have a message for Republicans in Washington who are giddy about the prospect—after years and years of trying—of finally repealing the ACA, the transformative program most closely affiliated with the eight-year administration of President Barack Obama: [ictt-tweet-inline]Step back and think about the people you’re elected to represent[/ictt-tweet-inline].

See, with all the ideological chest-thumping and rabid partisan rhetoric, with all the crowing about the political coup of gaining control of the White House and both chambers of Congress and what it will allow the GOP to do … not enough attention is being paid to the people who have the most to lose with this decision: the over 20 million Americans who currently have health coverage only because the ACA took an innovative approach to one of the most stubborn and damaging challenges in modern era—the lack of access to affordable health care.

What comes next for these Americans?

Unfortunately, no one knows and too few leaders seem to care.

Most of the “repeal and replace” talk—including from Kentucky’s own GOP delegation—over the years and even now continues to center on the “repeal,” with little serious consideration being dedicated to the far more complex problem of the “replace.” With decisions rooted firmly in ideology and political gain, the impact on actual families has been almost an afterthought.

The same reckless disregard has been true in Kentucky.
These people would get up every morning, go to work and roll the dice, hoping and praying that they didn’t get sick. They chose between food and medicine. They ignored checkups that would catch serious conditions early. They put off doctor’s appointments, hoping a lump or a pain turned out to be nothing. And they lived every day knowing that bankruptcy was just one bad diagnosis away.  
  I embraced the ACA for one simple reason: Kentucky’s collective health had long been terrible, and what we’d been doing for generations wasn’t working. In almost every measure of health there was, Kentucky ranked near the bottom or at the bottom and had for a long time. The suffering was deep. Kentuckians were sicker than most. We died too early. And our families were going bankrupt paying to treat diseases and chronic conditions. Our poor health also had devastating consequences for our state as a whole, as there was and remains a direct line between poor health and almost every challenge Kentucky faces—whether that’s poverty, unemployment, lags in education attainment, substance abuse or crime. Now, one of the biggest reasons for our poor health was lack of access. Before we expanded Medicaid eligibility and created our own state-based Health Benefit Exchange, an estimated 640,000 people in Kentucky were uninsured. That was almost one in six Kentuckians – putting both their health and financial security in jeopardy. These people would get up every morning, go to work and roll the dice, hoping and praying that they didn’t get sick. They chose between food and medicine. They ignored checkups that would catch serious conditions early. They put off doctor’s appointments, hoping a lump or a pain turned out to be nothing. And they lived every day knowing that bankruptcy was just one bad diagnosis away. Look, some politicians believe that these people are not deserving of health care because they’re poor, or because they work for an employer that doesn’t provide health care or it’s priced out of reach. They talk about them as if they are from some distant planet. But they’re not. They’re our friends and neighbors. Our former classmates and hunting buddies. We sit in the pews with them on Sunday and in the high school bleachers with them on Friday night. The Affordable Care Act gave us an opportunity to address this big problem in an aggressive way. And so—after consulting independent analysts who told me that yes, Kentucky would come out financially ahead if we did so—I moved forward. The result was phenomenal. In early 2016, a Gallup-Healthways survey measured Kentucky’s uninsured rate at 7.5 percent, down from more than 20 percent before the ACA. And even though better health outcomes tend to lag a few years behind health policy changes, a study by researchers at Harvard’s School of Public Health published in JAMA Internal Medicine in August 2016 found that already, low-income Kentuckians reported being in better health and were more likely to have a doctor, to have their chronic disease or condition treated and to have been screened for things like high blood sugar and high cholesterol, which are important in treating heart disease and diabetes. As for the effect on taxpayers and the state as a whole, a study in 2015 conducted by Deloitte Consulting and the University of Louisville Urban Studies Institute using hard data from our first year of expanded Medicaid, found that expansion generated 12,000 new jobs and $1.3 billion in new revenues for providers (increasing to almost $3 billion in the first 18 months of expansion).  It also projected a $300 million positive impact on the state’s 2016-18 annual budget and the creation of 40,000 new jobs and a $30 billion overall economic impact through 2021. There is a mountain of evidence demonstrating the success of the ACA in Kentucky. But that didn’t stop our newly elected governor, Matt Bevin, from claiming both that the ACA was not financially sustainable and that it wasn’t having an impact on health. He has no evidence, just ideology. In fact, he refuses to address all the evidence staring him in the face. Instead, he just says that low-income Kentuckians need to have “more skin in the game” and insists that making care harder to access will somehow make Kentuckians healthier. Recently he dismantled Kentucky’s exchange, called “kynect,” and moved to the federal insurance portal, needlessly complicating the process and destroying what was hailed as the nation’s most successful and simple exchange. Many advocates predict that enrollment numbers will drop. He also has applied for a Section 1115 waiver to administer Medicaid expansion, with the primary goal of saving money. By his projections, the waiver would save money, but only by cutting 88,000 people from eligibility rolls; eliminating vital benefits like dental, vision, and medical transportation; and imposing onerous administrative barriers like work requirements for eligibility, monthly premiums that increase the longer one is poor, lockout periods for not enrolling on time, and retroactive fines for emergency room visits later determined to be non-emergent. Medical professionals have warned that these steps will reduce enrollment and access and hurt care. Families and their advocates across the state used public comment periods to voice their outrage and anxiety. But the criticism has only strengthened the governor’s resolve. Even though parts of the waiver application run contrary to the goals of Medicaid and the waiver program (which should make the application impossible for the federal government to approve), Gov. Bevin has threatened repeatedly to get rid of expansion altogether if his waiver isn’t approved as written. That would strip health coverage from 400,000 vulnerable Kentuckians with a stroke of a pen. Again, it seems that ideology is more important than the fate of actual families. I fear the same result in Washington on a national scale. This isn’t about President Obama but about American families. And while there are some issues with the ACA that need to be addressed, there is also undeniable proof that it has strengthened this nation at its core. That’s why I urge our leaders to take a deep breath, let the reckless partisan fervor subside and ask themselves: What will happen to the 20-plus million Americans who have been put on the path toward hope and better health? Featured Image: Kentucky Democratic Party, Governor Steve Beshear, used under CC BY-NC 2.0 [post_title] => ACA Politics: Lessons from Kentucky [post_excerpt] => Steven Beshear, former Governor of Kentucky, the state that most aggressively embraced and succeeded in implementing the Affordable Care Act as a core part of a holistic strategy to improve its collective health, suggests putting partisan fervor aside. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => lessons-from-kentucky [to_ping] => [pinged] => [post_modified] => 2017-08-26 23:28:21 [post_modified_gmt] => 2017-08-27 03:28:21 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_viewpoint&p=663 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Steven Beshear, former Governor of Kentucky, the state that most aggressively embraced and succeeded in implementing the Affordable Care Act as a core part of a holistic strategy to improve its collective health, suggests putting partisan fervor aside.

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Why Porn is a Public Health Issue

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                    [post_content] => It was not that long ago that domestic violence (DV) was seen as a private family issue, rather than a public health problem of enormous magnitude that has myriad effects on the social, psychological, economic and, of course, collective health of society at large. Thanks in large part to the feminist movement, which worked to build public awareness about the multiple harms of DV, health professionals drawn from a number of areas of specialization now understand DV as an issue that requires both prevention and intervention.

We have now reached a similar tipping point with pornography.  As the evidence on the harms of pornography piles up, it has become clear that [ictt-tweet-inline]we can no longer sit back and allow the porn industry to hijack the sexual and emotional well-being of our culture[/ictt-tweet-inline]. Extensive scientific research reveals that exposure to porn threatens the social, emotional and physical health of individuals, families and communities. These impacts highlight the degree to which [ictt-tweet-inline]porn is a public health crisis that undermines women and children's human rights[/ictt-tweet-inline], rather than being a private matter. But just as the tobacco industry argued for decades that there was no proof of a connection between smoking and lung cancer, so too has the porn industry, with the help of a well-oiled public relations machine, denied the existence of empirical research on the impact of its products.

Using a wide range of methodologies, researchers from a number of disciplines have shown that viewing pornography is associated with damaging outcomes. In a study of U.S. college men, researchers found that 83 percent reported seeing mainstream pornography, and that those who did were more likely to say they would commit rape or sexual assault (if they knew they wouldn’t be caught) than men who hadn’t seen porn in the past 12 months. The same study found that porn consumers were less likely to intervene if they observed a sexual assault taking place. A recent meta-analysis of 22 studies between 1978 and 2014 from seven different countries concluded that pornography consumption is associated with an increased likelihood of committing acts of verbal or physical sexual aggression, regardless of age. A 2010 meta-analysis of several studies found “an overall significant positive association between pornography use and attitudes supporting violence against women.”

 
In one of the most respected and highly cited studies on the content of pornography, Bridges and her team found that the majority of scenes from 50 of the top-rented porn movies contained both physical and verbal abuse targeted against the female performers.  
  This is no surprise given the violent and degrading nature of mainstream online pornography. In one of the most respected and highly cited studies on the content of pornography, Bridges and her team found that the majority of scenes from 50 of the top-rented porn movies contained both physical and verbal abuse targeted against the female performers. Physical aggression, which included spanking, open-hand slapping, and gagging, occurred in over 88% of scenes, while expressions of verbal aggression—calling the woman names such as “bitch” or “slut”—were found in 48% of the scenes. The researchers concluded that 90% of scenes contained at least one aggressive act if both physical and verbal aggression were combined. As Carin Götblad, Police Commissioner of Stockholm County, said about preventing DV, "there are no simple overall solutions.... what is needed is long-term, differentiated and sustained cooperation throughout society: efforts with a clear public health perspective." Culture Reframed (full disclosure: the author is the founder and President of the organization) is pioneering such a strategy to address porn as the public health crisis of the digital age. Tasked with building the public’s capacity to deal with online porn, our multi-disciplinary team of expert consultants is developing educational programs for parents, youth, and a range of professionals. These programs will create a robust set of health objectives that adhere to best practice in health promotion and violence prevention, and that align with the U.S. national health priorities and the U.S. national health policy, Healthy People 2020. These objectives serve to guide the development of our curriculum, evaluation, implementation, and long-term strategic plans. As with DV, the problem of pornography requires a creative and collective effort by building coalitions and partnerships, which Dr. Nidal Karim, a behavioral scientist with the Centers for Disease Control calls "the cornerstone of success." At Culture Reframed we recognize that organizing against a predatory misogynist industry demands that we work with multiple partners that include sex educators, parents, youth groups, health professionals, and anti-violence experts, to shift the culture from one that sees pornography consumption as a private issue to one that values and promotes a sexuality rooted in gender equality, dignity, autonomy, and consent. Featured image: laurenAmsterdam, The Netherlands. 2007, used under CC BY 2.0 [post_title] => Why Porn is a Public Health Issue [post_excerpt] => It was not that long ago that domestic violence was seen as a private family issue, rather than a public health problem of enormous magnitude. Gail Dines argues we have now reached a similar tipping point with pornography. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => pornography-public-health-issue [to_ping] => [pinged] => [post_modified] => 2017-12-07 14:15:04 [post_modified_gmt] => 2017-12-07 19:15:04 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_viewpoint&p=635 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

It was not that long ago that domestic violence was seen as a private family issue, rather than a public health problem of enormous magnitude. Gail Dines argues we have now reached a similar tipping point with pornography.

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Viewpoint

How Public Health Can Show Up (for Police Reform)

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                    [post_content] => A mandate of public health is to improve health equity, promote public safety, advance prevention, and strive for social justice. With this in mind, as I process the results of the election and the uncharted, unprecedented future there is a whisper of a question that’s growing louder: what can public health do? At Human Impact Partners, we work to carry out this public health mandate by partnering with movements on the front lines of policy change for social justice. Last year, we were privileged to partner with two knowledgeable and committed partners—Ohio Justice & Policy Center and Ohio Organizing Collaborative—to research the health impacts of policing on Black communities and police officers.

The lessons I learned from this research project can help answer a piece of the question, at least. Below are [ictt-tweet-inline]four specific ways that public health practitioners can show up to work on policing reform[/ictt-tweet-inline]:

1.     Collect data. Fill gaps in data nationwide about the mortality and morbidity attributed to police interactions. At the 2016 American Public Health Association meeting, we were honored to share reflections from the project in Ohio as part of a timely and thoughtful session on policing and public health data. Participants shared a collective sigh about the lack of mandatory, consistent, real-time data available nationwide from governmental datasets about police-involved incidents. In the meantime, non-governmental data from sources like the Guardian’s “The Counted” help fill gaps. There also are data reporting systems combing down the pike at a federal level, but they will continue to be voluntary. One approach that Dr. Nancy Krieger and colleagues are leading in Massachusetts calls for making police-involved deaths a notifiable condition. This is a great and actionable step well within the bounds of public health. More states need to work on making this happen. In addition to deaths, it will be important to capture the associated morbidity, as well as impacts to not only the individuals directly affected but those to households, families, and communities.

2.     Participate in local efforts. There are various ways that public health practitioners can participate in criminal justice reform work happening in their neighborhoods—the point is to participate. In the “Trust not Trauma” effort, staff from a public health department and from health policy groups joined the Advisory Committee guiding the project. Health departments also can lead making requests to police departments for data in a cross-agency cooperation. In a separate example of participating in local efforts, a pediatrician in the Bay Area of California played a large role in organizing fellow public health advocates to write a letter to the San Francisco Police Commission and Department about a public health response to violence during interactions with police.
One approach that Dr. Nancy Krieger and colleagues are leading in Massachusetts calls for making police-involved deaths a notifiable condition. This is a great and actionable step well within the bounds of public health.  
  3.     Fill research gaps. There is a new but small literature about how policing directly affects health. However, there are important gaps to fill, as described in this interview with Public Health Magazine. It includes direct connections from policing practices to not only physical, but also mental and emotional health. There are impacts to individuals involved in these interactions but also their households, families, and the public that witnesses events. The cumulative and long-term effects to these populations must be better understood if we are to grasp the full scope of impacts. 4.     Speak publicly, and often. Whether it’s being quoted in a press release—as a person who works at a public health department was in the Ohio project—or talking one-on-one with the public, legislators, law enforcement, media, or others, we in public health have a voice that is valuable, relevant, and powerful. So we need to speak. Work is building nationally both among professional organizations like the National Association of County & City Health Officials who publicly released a statement on Health, Racism, and Police Violence or the American Public Health Association’s statement on the Impact of Police Violence and Public Health, and in efforts by a variety of individuals to advance and publicize a collective vision to improve public health and criminal justice systems. For more on the Ohio report, visit www.TrustNotTrauma.org. Featured image: Mite Kuzevski, Protests against police brutality Day 20, Skopje, Macedonia, can be reused under the CC BY license/cropped from the original [post_title] => How Public Health Can Show Up (for Police Reform) [post_excerpt] => Sara Satinsky discusses four specific ways that public health practitioners can show up to work on policing reform. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => public-health-can-show-police-reform [to_ping] => [pinged] => [post_modified] => 2017-08-26 23:26:16 [post_modified_gmt] => 2017-08-27 03:26:16 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_viewpoint&p=629 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Sara Satinsky discusses four specific ways that public health practitioners can show up to work on policing reform.

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Viewpoint

A Pakistani-American In Trump’s America

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                    [post_content] => I think it is prudent to reveal my own bias right off the bat: I was named after Faiz Ahmed Faiz—Pakistan’s most famous poet, and a committed Marxist dissident. Consequently, one could say that my political leanings were predestined. Now you know one thing about me, and here is another that you may have already deduced: I am Pakistani-American. I immigrated to the U.S. almost 10 years ago when I was 15 years old. I attended high school in Bloomington, a progressive small town in Indiana, home to Indiana University’s flagship campus. In high school, I felt the memories of 9/11 were still too fresh for me be myself. I was dishonest about my origins; I told some that I was from India, and to others I said I was from somewhere else. I picked up the American accent fairly quickly, which is why most people were none the wiser. My “dirtiest” secret perhaps, was that I was a closet-Muslim. I remember praying in dark and dingy corridors, lest someone find out who I was.

When I did begin poking a toe or two out of my closet, I was surprised to find out that my fears were real, but exaggerated. I was met with kindness and affection. This kindness and affection saw me all the way through college, graduate school, and into medical school. I especially remember my social studies teacher, Steve Philbeck (to whom I owe a lot) who would allow me to pray in his classroom if I ever needed to—my first ever safe space. That said, it would be disingenuous of me to paint an all too rosy picture. I distinctly remember being once called a terrorist, and another time being asked where we were hiding Bin Laden.

The reasons I delve so deeply into my background in this piece are twofold; one, because it’s cathartic, as it reminds of a time when our country was, at least ostensibly, less divided. And second, because it has crafted the lens with which I view the results of this election.

 
The results of this election do imbue me with a modicum of hope. We now have something tangible that we can work with to take the next step towards diluting this climate of hate which is fueled in large part by economic frustration.  
  What surprised me most during this election cycle is that [ictt-tweet-inline]many of my friends and acquaintances who like me and want to see me succeed, still voted for Donald Trump[/ictt-tweet-inline]. We must resist the temptation to reduce all of the President-elect’s supporters as racists, xenophobes, bigots, and sexists. Trump tapped into a legitimate anger among working class white Americans towards stagnating upward mobility. Recently, Saturday Night Live did a skit where Tom Hanks plays a Trump supporter on Black Jeopardy, who does remarkably well and gets along famously with the black contestants, showing that they have similar grievances. This is what makes Trump’s sin so grave: he has misdirected legitimate anger towards minorities who are suffering under the yolk of the same economic policies. [ictt-tweet-inline]The results of this election do imbue me with a modicum of hope[/ictt-tweet-inline]. We now have something tangible that we can work with to take the next step towards diluting this climate of hate which is fueled in large part by economic frustration. As Nicholas Kristoff writes, economic frustration doesn’t necessarily stem from materialistic privation, but from the lack of hope in a better tomorrow. This is where public health can play an important role because we know we cannot improve a community’s health without improving its socioeconomic status. This is by no means a groundbreaking revelation. It is, however, a call to redouble our efforts upon improving the social determinants of health. I am not naïve. I realize that there is a virulent strain of racism in America that becomes ever more conspicuous during election season. Unsavory characters have always been a feature in America’s tapestry. After they were disowned by the Democratic Party, they latched themselves to the Republican Party. As far as unsavory politicians go, we have seen them off too; compared to George Wallace and President Andrew Johnson, Donald Trump sits low on the totem pole. In the short term, it is clear what we all have to do on an individual level; we must build a wall. A wall between the hate that Mr. Trump’s campaign has emboldened and the people towards whom it is directed. Unlike Mr. Trump’s fantasy, [ictt-tweet-inline]this wall isn’t built with concrete, but with radical compassion and empathy[/ictt-tweet-inline]. Author's acknowledgment: I would like to acknowledge the contributions of Jen Hawkins to this piece. Thank you for your friendship and wisdom. Photo courtesy of the author. [post_title] => A Pakistani-American In Trump’s America [post_excerpt] => "We now have something tangible that we can work with to take the next step towards diluting this climate of hate which is fueled in large part by economic frustration." [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => pakistani-american-trumps-america [to_ping] => [pinged] => [post_modified] => 2017-08-26 23:24:25 [post_modified_gmt] => 2017-08-27 03:24:25 [post_content_filtered] => [post_parent] => 0 [guid] => http://www.publichealthpost.org/?post_type=bu_viewpoint&p=559 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

“We now have something tangible that we can work with to take the next step towards diluting this climate of hate which is fueled in large part by economic frustration.”

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Viewpoint

What is Public Health?

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                    [post_content] => We are about to witness a major fight over the fate of Obamacare. This is an important moment in U.S. social policy with very serious implications for millions of people. Let's be clear though, the current fight over health reform is mostly about health insurance. But having an insurance card does not guarantee that someone will have access to health care. Even if they do get care, it might not be timely, effective, efficient, affordable, safe, or culturally sensitive. Most importantly, [ictt-tweet-inline]providing access to fantastic health care is not the best way to improve the health of populations[/ictt-tweet-inline].

Insuring every American is not our ultimate goal. That is a crucial means to the broader goal of being a healthier nation. Population health should transcend the partisan politics surrounding the Affordable Care Act. There are many policies that would improve health that can be expected to win support from people on all sides of the political spectrum. We will have to navigate political mind fields about the role of government and the use of public funds, but [ictt-tweet-inline]I am convinced consensus on public health priorities is possible.[/ictt-tweet-inline]

The upcoming fight is a crucial opportunity for public health to step up, assert its place in the broader debate about health reform, and chart a bi-partisan path to enacting policies that improve health. We can already point to a number of successes. For example, public health leaders have argued that it is more efficient and morally superior to prevent smoking than to get better and better at treating lung cancer.

Public Health Post is one place for this conversation to happen. In the coming weeks we will feature articles from people making the case for public health. We will talk about issues ranging from cyber-bullying to maternal mortality. We will also use this the site as a safe space for people to reflect on what Trump’s victory means to them and for the country’s health.

Today we start with a video we like from the American Public Health Association addressing the question: what is public health? We would love your answers to this question. Email us or connect on Twitter @pubhealthpost if you want to add your voice.



Feature image: Conniea friendly message from Winston, used under CC BY 2.0. "What is Public Health?," video courtesy of the American Public Health Association. 
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                    [post_excerpt] => We are about to witness a major fight over the fate of Obamacare. This is an important moment in U.S. social policy with very serious implications for millions of people. Public health needs to step up and assert its place in the debate over health reform.
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We are about to witness a major fight over the fate of Obamacare. This is an important moment in U.S. social policy with very serious implications for millions of people. Public health needs to step up and assert its place in the debate over health reform.

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Viewpoint

Hiding in Homophobia as a Gay Student in Senegal

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                    [post_content] => There was a case of Ebola in a nearby neighborhood, and I was tested for malaria, but nothing proved to be more feverish than living as a gay student in Dakar during my senior year of college. I wouldn’t have survived Senegal without my running shoes and a pen. Jogging along the Atlantic Ocean and journaling in my notebook allowed me to escape from hiding in the closet once more.

In August 2014, [ictt-tweet-inline]I traveled to Senegal to spend four months interning for a global health organization and learning Wolof[/ictt-tweet-inline]. I made an unconscious decision to study in an anti-gay space and never realized I was to hide in the closet once more because Senegal is one of 38 African countries that penalizes homosexuality. During my four months abroad, I lived as an American in Senegal[ictt-tweet-inline] speaking Wolof in the streets and French at home, all while lying about my sexual orientation[/ictt-tweet-inline] to my Senegalese host family and friends. Speaking a new language, living in a new place, and taking on a new family name only augmented my crise d’identité.

An American living abroad, I followed Senegalese law. Penal codes 320 and 321 define homosexuality as an “act against nature,” and perpetrators can face one to five years in prison coupled with a $3,000 fine. Living openly gay in Senegal was dangerous. Months before my arrival, the Associated Press reported the story of two Senegalese men who were sentenced and imprisoned in Dakar on charges of homosexuality.

Senegal is not the only country in francophone West Africa to codify systemic homophobia. Gay Gambians flee to Senegal to escape President Jammeh’s crackdown because the situation is often more precarious for LGBT citizens in Banjul than in Dakar. He hopes to “fight these vermins [sic] called homosexuals or gays the same way we are fighting malaria-causing mosquitoes, if not more aggressively.”

My host family asked if I had an American girlfriend, and I lied saying yes. Senegalese friends would ask if I was looking for a Senegalese wife, and I bashfully laughed.

In a Saharan village near Mauritania, a woman offered her sister to me within minutes of first meeting, and I smiled uncomfortably. During a presentation on the role of women in Senegalese society, I retold that story, and my professor asked if she was pretty. I feared telling him that I was gay in class because I didn’t know how it would affect my grade in the course.
My host family asked if I had an American girlfriend, and I lied saying yes. Senegalese friends would ask if I was looking for a Senegalese wife, and I bashfully laughed.  
During dinner with my host family, the news reported about same-sex marriage in Italy. My host brothers stared at the news unwillingly and then quickly changed the channel. I put my head down while continuing to eat communally around the bowl with them, which is supposed to be an expression of hospitality. After the first two months of my program, I needed an outlet. I contacted Djamil Bangoura who established Association Prudence, Senegal’s largest LGBT health and human rights advocacy group. He met me for coffee to introduce himself, the community, and his work. Bangoura’s welcoming me to the community and his organizing LGBT Senegalese shaped my own research interests within global health. His ability to improve health outcomes for vulnerable populations moved me to focus on sex, sexuality, gender, and health in francophone Africa. The silence about LGBT health in Senegal also moved me to hear their voices. In May 2016, I returned to Senegal for another three months as a graduate student from the Boston University School of Public Health to interview men who have sex with men (MSM). Bangoura connected me with six MSM willing to share their coming out stories, their experiences facing stigma, and their scars. Once they finished praying and preparing tea, we met at Prudence’s Dakar office. Prudence invited me several times to their organization, and we spent weeks together interviewing and discussing gay life in Senegal and the United States. After one of our interviews, Amadou asked me how I felt about the Pulse shootings, a hate crime and terrorist attack that targeted our community during Pride month. He was the only Senegalese to reach out to me about Orlando, and I so appreciated his empathy. Amadou’s gesture revealed the commonalities between American and Senegalese MSM, even if 3,694 miles separate our LGBT communities. I continued to lie to my host family and friends about my research upon returning to Senegal. Knowing I needed to disguise myself like my brothers at Prudence, hiding my sexual orientation once more became a way to find a safe space. [ictt-tweet-inline]The Senegalese LGBT community will continue to hide in homophobia[/ictt-tweet-inline], and it seems unlikely that I will see them accepted and integrated. That’s part of what made leaving and returning to Senegal so difficult for me. Editor's note: This is part one of a four-part series on LGBT health in Senegal. Click here to read parts twothree, and four. An earlier version of this article was published in the Albion Pleiad in January 2015. The informants’ names are changed to protect their safety. Feature image: Jeff Attaway, Dakar Rain, About to rain..., used under CC BY 2.0/cropped from original  [post_title] => Hiding in Homophobia as a Gay Student in Senegal [post_excerpt] => Part one of PHP's four-part series on LGBT health in Senegal. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => hiding-homophobia-gay-student-senegal [to_ping] => [pinged] => [post_modified] => 2018-02-22 12:15:04 [post_modified_gmt] => 2018-02-22 17:15:04 [post_content_filtered] => [post_parent] => 0 [guid] => http://publicpost.wpengine.com/?post_type=bu_viewpoint&p=252 [menu_order] => 0 [post_type] => bu_viewpoint [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Part one of PHP’s four-part series on LGBT health in Senegal.

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