Inner city women with severe mental illness may carry multiple stigmatized statuses. In some contexts these include having a mental illness, being a member of an ethnic minority group, being an immigrant, being poor, and being a woman who does not live up to gendered expectations. These potentially stigmatizing identities influence both the way women's sexuality is viewed and their risk for HIV infection. This qualitative study applies the concept of intersectionality to facilitate understanding of how these multiple identities intersect to influence women's sexuality and HIV risk. We report the firsthand accounts of 24 Latina women living with severe mental illness in New York City. In examining the interlocking domains of these women's sexual lives, we find that the women seek identities that define them in opposition to the stigmatizing label of "loca" (Spanish for crazy) and bestow respect and dignity. These identities have unfolded through the additional themes of "good girls" and "church ladies". Therefore, inspite of their association with the "loca", the women also identify with faith and religion ("church ladies") and uphold more traditional gender norms ("good girls") that are often undermined by the realities of life with a severe mental illness and the stigma attached to it. However, the participants fall short of their gender ideals and engage in sexual relationships that they experience as disempowering and unsatisfying. The effects of their multiple identities as poor Latina women living with severe mental illness in an urban ethnic minority community are not always additive, but the interlocking effects can facilitate increased HIV risks. Interventions should acknowledge women's multiple layers of vulnerability, both individual and structural, and stress women's empowerment in and beyond the sexual realm.

Das Vorhaben wurde mit Mitteln des Bundesministeriums für Bildung und Forschung im Rahmen des Programms ‚Präventionsforschung' unter dem Förderkennzeichen 01EL1823A bis 01EL1823H gefördert. Die Open-Access-Veröffentlichung wurde zusätzlich von der Hochschule Neubrandenburg, der Katholischen Hochschule für Sozialwesen Berlin und der Hochschule Esslingen gefördert.

Urban women with severe mental illness (SMI) are vulnerable to stigma and discrimination related to mental illness and other stigmatized labels. Stigma experiences may increase their risk for negative health outcomes, such as HIV infection. This study tests the relationship between perceived stigma and HIV risk behaviors among women with SMI. The authors interviewed 92 women attending community mental health programs using the Stigma of Psychiatric Illness and Sexuality Among Women Questionnaire. There were significant relationships between personal experiences of mental illness and substance use accompanying sexual intercourse; perceived ethnic stigma and having a riskier partner type; and experiences of discrimination and having a casual or sex-exchange partner. Higher scores on relationship stigma were associated with a greater number of sexual risk behaviors. The findings underscore the importance of exploring how stigma attached to mental illness intersects with other stigmatized labels to produce unique configurations of HIV risk. HIV risk reduction interventions and prevention research should integrate attention to stigmatized identities in the lives of women with SMI. NIH-PA Author ManuscriptMany urban women living with severe mental illness (SMI) expose themselves to considerable HIV risk during sexual encounters (Meade & Sikkema, 2005; Wright, Wright, Perry, & FooteArdah, 2007). In fact, the prevalence of HIV infection among people with SMI is much higher than in the general population in the United States (McKinnon, Cournos, & Herman, 2002). Among women, in particular, elevated HIV prevalence and risk stem from vulnerability to coercion and victimization, gender dynamics that result in power imbalances, unprotected sex, trading sex for money or other goods, sex with high-risk partners, and substance use (Amaro, 1995;Meade & Sikkema, 2005;Otto-Salaj, Heckman, Stevenson, & Kelly, 1998). Questions remain about the context in which these factors emerge to shape women's experiences of HIV risk.Stigma related to mental illness may be one contextual risk factor that shapes health outcomes in the lives of women with SMI; stigma may facilitate some of the sexual risk factors noted above. Contextual risk factors such as stigma affect access to power, money, knowledge, and social connectedness, all of which influence disease risk (Link & Phelan, 1995). Less understood is whether, and through which mechanisms, this stigma affects the sexual lives of women with SMI. suggested that stigma occurs when differences are labeled and distinguished; labeled people are linked to stereotypes and distinguished as "other" or "them"; they experience status loss and discrimination. When these components are mobilized by individuals, communities, or governments with greater power, they result in reduced opportunities, rejection, and discrimination for the stigmatized group. Furthermore, laws and institutions that support power relationships maintain these unequal outcomes that stigma produces, thus creating structural ...

Participatory health research (PHR) has emerged as an important approach for addressing local health issues, including building capacity for health promotion. Increasingly, PHR is drawing the attention of communities, funders, decision-makers and researchers worldwide. It is time to consolidate what we know about PHR in order to secure its place as a source of knowledge and action for public health. This can be achieved through an International Collaboration on Participatory Research for Health to addresses the following issues:Set a framework in which information can be exchanged, decisions can be reached and information can be disseminated on central issues in PHR. Provide an international forum to discuss standards and quality. Produce guidelines for researchers, practitioners and community members. Synthesize the findings of PHR internationally. Formulate recommendations regarding generalizable findings. Similar to the Cochrane Collaboration on clinical trials research, the PHR Collaboration will be dependent on a host of experts from various countries to bring together what we know about PHR and to make that knowledge accessible to an international audience. Unlike the Cochrane Collaboration, the PHR Collaboration will include both quantitative and qualitative research approaches. The goal of the PHR Collaboration will not be able to achieve a standardization of research protocols, but rather to find meaningful ways to judge the quality of PHR and to report on its findings while respecting the variety of locally based approaches to research design, data collection and interpretation.

Background: A seminar course was developed in order to train medical students in qualitative research methods, while providing an introduction to the field of General Practice. Students were enabled to conduct semi-structured interviews with general practitioners (GPs), during which they learned about the prevention, diagnosis, and treatment of frequently encountered medical problems. The course was carried out four times at two universities in Germany. Aims: The study explores the students' learning experiences focusing on their research experience. Methods: Data were collected in four focus groups and analyzed. Results: The students perceived the course as very different from their usual medical education. This was appreciated, but also caused some difficulties. Three themes emerged: (1) Missing 'facts', (2) New horizons: 'Thinking outside the box', and (3) The challenge of interpretation: 'Reading between the lines'. Conclusions: Learning qualitative research methods can be particularly challenging for medical students as the tasks and epistemology of qualitative research run counter to the usual learning formats and research paradigms in medical education. When teaching qualitative research, special care should be taken to address the cognitive dissonance experienced by students and to explain the unique contribution of qualitative research to medical practice and the field of General Practice especially.