Showing posts with label Hawaii. Show all posts
Showing posts with label Hawaii. Show all posts

Monday, March 14, 2016

RaeRae & Mahu: Third Polynesian Gender

Background 
On numerous islands of the Pacific, under various names, there are people considered to be neither men nor women but half-men/half-women. In French Polynesia, there is a sociological and anthropological condition called RaeRae or Mahu. A RaeRae is a man who behaves as and considers himself to be a woman. RaeRae and Mahu are good examples of culture-bound transsexuality or cross-dressing. Being Mahu has a cultural meaning, recognized in the history of Polynesian society, and cannot be considered as a medical or psychiatric condition. Being RaeRae extends the transformation to possible hormone therapy and surgery; the traditional social role (education, tourism) of Mahu is retained but in some cases is influenced by prostitution and at-risk homosexuality.

Bibliographic sources and method 
We conducted a literature search using several medical, social, and anthropological bibliographic sources (MedLine, Google Scholar, PsycINFO, DUMAS). We used the terms RaeRae, Mahu, Polynesian androphilia, and Polynesian sexuality. We found 20 articles and theses. Some articles discuss a very similar condition in Samoa (fa'afafine). In addition, Mahu seems to be a derogatory term for a male homosexual or drag queen in the Hawaiian Islands.

Results and contents 
RaeRae and Mahu is broadly defined as men with sweetness [OK?] or women who are prisoners of men's bodies. There is evidence of their presence and social functions in ancient times. The arrival of the missionaries and Christian morality resulted in the emergence of a new moral and sexual order. RaeRae and Mahu remain present and visible today. They are integrated into local professional and cultural life and are accepted, as long as their sexuality remains unspoken and invisible, which is more difficult for RaeRae. We describe the phenomenon and its context and the sociocultural hypotheses. We retain a reference connected to tacit knowledge of Polynesian sacrificial rites: Mahu did not undergo sacrifices the victims of which had to be men. 

A general discussion must be envisaged concerning the DSM-5, transgender identity and stigmatization. For instance, in Hawaii, people who identify as transgender continue to suffer high rates of violence, sexual assault and discrimination. The description contributes to an investigation of the limits of considering gender as binary; rather, it is a continuum not governed by the medicalization and psychologization of a cultural feature, which is also recognizable in other cultural areas including among the Amerindians. Studying RaeRae and Mahu in Polynesia means agreeing to confront the binary concept that structures and divides the world into two categories of gender and sex, male and female, just like grammatical gender in French. Examples from other cultures include the new half in Japan, muxe or muché among the Zapotecs of Tehuantepec, woubi in Côte d'Ivoire, femminielli in Italy, ladyboys or kathoeys in Thailand, natkadaw in Myanmar, hijra in India and Pakistan, khounta in Arab Islamic culture, and in Canada and the USA, agokwa among the Ojibwa, and ikoneta in the Illinois language. Mahu, or transgendered individuals and transvestites, were in fact viewed by the ancient Hawaiians as a normal element of the old social culture that preceded missionary days and American and French military missions. Mahu were not merely tolerated; they were regarded as a legitimate and contributory part of the ancient Polynesian community.

Purchase full article [in French] at:   http://goo.gl/KkQqTt

By:  Stip E1.
1CHUM; CR-IUSMM, CR-HSCM, Département de psychiatrie, Université de Montréal.
Sante Ment Que. 2015 Fall;40(3):193-208.




Tuesday, January 5, 2016

Trends in Injection Drug Use among High School Students, U.S., 1995-2013

INTRODUCTION:
Injection drug use is the most frequently reported risk behavior among new cases of hepatitis C virus infection, and recent reports of increases in infection are of great concern in many communities. This study assessed the prevalence and trends in injection drug use among U.S. high school students.

METHODS:
Data were from CDC's Youth Risk Behavior Surveillance System, which collects information on health risk behaviors at the national, state, and large urban school district levels. Analyses were conducted in 2014.

RESULTS:
In 2013, 1.7% of high school students nationwide had ever injected any illegal drug. Nationwide, ever injecting any illegal drug did not change significantly from 1995 to 2013, except among black non-Hispanic students. For this subgroup, both a significant linear increase from 1995 to 2013 and a significant quadratic trend were observed, with injection drug use increasing from 1995 to 2009 and decreasing from 2009 to 2013. 
  • Significant linear increases in injection drug use occurred in five states (Arkansas, Hawaii, Maine, Maryland, and New York) and six large urban school districts (Baltimore, Memphis, Miami-Dade County, New York City, Philadelphia, and Seattle). 
  • Significant linear decreases occurred in three states (Massachusetts, South Dakota, and West Virginia). Both a significant linear increase and quadratic trend were observed in Maine; quadratic trends were observed in Tennessee, Utah, and Palm Beach County, Florida. 

CONCLUSIONS:
In some geographic areas and population groups, an increasing or high frequency of injection drug use was found among high school students, who should be targeted for prevention.

Purchase full article at:   http://goo.gl/ULDYwY

1Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia. Electronic address: rmk2@cdc.gov.
2Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia.
3Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia.
Am J Prev Med. 2016 Jan;50(1):40-6. doi: 10.1016/j.amepre.2015.05.026. Epub 2015 Aug 24.


Tuesday, December 22, 2015

Unintended Pregnancy in the Native Hawaiian Community: Key Informants’ Perspectives

CONTEXT
Native Hawaiians experience the highest reported rate of unintended pregnancy of any ethnic group in Hawaii. Understanding the context in which they make decisions that influence pregnancy and pregnancy planning is essential to reducing this rate.

METHODS
A qualitative study was carried out in partnership with a community health center serving a large Native Hawaiian population to explore how Native Hawaiians conceptualize pregnancy and pregnancy planning. Between August and October 2013, semistructured interviews were conducted with 10 diverse key informants from the Hawaiian community. Content analysis was used to identify themes and patterns that emerged from the interviews.

RESULTS
Core Hawaiian values of children and family strongly affect how Native Hawaiians view pregnancy, pregnancy planning and unintended pregnancies. ‘Ohana (families) are large and characterized by tremendous support, which is perceived to lessen the burden of an unintended pregnancy. Pregnancies, whether planned or not, are seen as blessings because children are highly valued. Because of these concepts, there is an expectation for women to continue unplanned pregnancies. Although Hawaiians ascribe value to planning pregnancies and hope that children are born under what they identify as ideal circumstances, they acknowledge that these circumstances are not necessary and often do not occur.

CONCLUSION
The concepts of family and children serve as core values to Native Hawaiians and are linked to the ways in which they view pregnancy and pregnancy planning.

Purchase full article at:   http://goo.gl/MvRTyA

By:   
  • Reni Soon1
  • Jennifer Elia2
  • Nina Beckwith3
  • Bliss Kaneshiro4 and
  • Timothy Dye5
    1. 1
      Assistant professor, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu
    2. 2
      Junior researcher, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu
    3. 3
      Medical student, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu
    4. 4
      Associate professor, Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu
    5. 5
      Professor, Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 


    Wednesday, December 9, 2015

    Addressing Risk and Reluctance at the Nexus of HIV and Anal Cancer Screening

    Anal cancer disproportionately burdens persons living with human immunodeficiency virus (PLHIV) regardless of natal sex, sexual orientation, gender expression, and ethnic identity. Culturally competent communications are recommended to address health disparities, with sociocultural relevance ensured through constituent dialogic processes. 

    Results are presented from six provider focus groups conducted to inform the promotion/education component of a Hawai'i-based project on anal cancer screening tools. Krueger's focus group methodology guided discussion queries. Verbatim transcripts of digitally recorded discussions were analyzed using grounded theory and PEN-3 procedures. Adherence to an audit trail ensured analytic rigor. 

    Grounded theory analysis detected the overall theme of risk and reluctance to anal cancer screening, characterized by anal cancer not being "on the radar" of PLHIV, conflicting attributions of the anus and anal sex, fear of sex-shaming/-blaming, and other interrelated conceptual categories. PEN-3 analysis revealed strategies for destigmatizing anal cancer, through "real talk" (proactive, candid, nonjudgmental discussion) nested in a framework of sexual health and overall well-being, with additional tailoring for relevance to Native Hawaiians/Pacific Islanders, transgender persons, and other marginalized groups. 

    Application of strategies for health practice are specific to the Hawai'i context, yet may offer considerations for developing strengths-based, culturally relevant screening promotion/education with diverse PLHIV in other locales.

    Purchase full article at:  http://goo.gl/Ku8PX0

    • 1University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA lskaopua@hawaii.edu.
    • 2University of Hawai'i Cancer Center, Honolulu, HI, USA.
    • 3University of Hawai'i-Ma-noa, Honolulu, HI, USA University of Hawai'i Cancer Center, Honolulu, HI, USA.
    • 4University of Hawai'i-Ma-noa, Honolulu, HI, USA.
    • 5Life Foundation of O'ahu, Honolulu, HI, USA. 





    Tuesday, September 29, 2015

    Gonococcal Susceptibility to Cephalosporins—Hawaii, 2003 to 2011

    Among gonococcal isolates examined at the Hawaii State Laboratory Division from 2003 to 2011, the prevalence of elevated cefixime minimum inhibitory concentrations (MICs; ≥0.064 μg/mL) and elevated cefpodoxime MICs (≥0.19 μg/mL) increased over time. In contrast, few isolates exhibited elevated ceftriaxone MICs (≥0.094 μg/mL), and the prevalence of elevated ceftriaxone MICs did not change.

    Below:  Proportion of gonococcal isolates with an elevated cefixime MIC (MIC ≥0.064 μg/mL) and elevated cefpodoxime MIC (MIC ≥0.19 μg/mL)—HGCSP, 2003 to 2011. *There was no cefixime testing, July 2004 to December 2009; testing for cefpodoxime started in April 2004.


    TABLE 1

    Prevalence of Elevated Cefixime MICs (MIC ≥0.064 μg/mL) in Patients With N. Gonorrhoeae Infection and Cefixime MIC Results—HGCSP, 2003 to 2004* and 2010 to 2011
    2003–2004*
    2010–2011
    PrevalencePR (95% CI)PPrevalencePR (95% CI)P
    Sex
     Male  6/320 (1.9%)0.8 (0.3–2.4)  0.7169/293 (23.6%)4.1 (1.7–9.8)<0.01
     Female  7/304 (2.3%)Reference  —    5/87 (5.8%)Reference
    Age, y
     ≤19    1/87 (1.2%)  0.4 (0.05–3.0)  0.34    8/40 (20.0%)1.0 (0.5–2.0)  0.99
     20–29  8/267 (3.0%)Reference  —41/206 (19.9%)Reference  —
     30–39  3/161 (1.9%)0.6 (0.2–2.3)  0.47  14/75 (18.7%)0.9 (0.5–1.6)  0.82
     ≥40  1/109 (0.9%)  0.3 (0.04–2.4)  0.23  11/59 (18.6%)0.9 (0.5–1.7)  0.83
    Race/Ethnicity
     Asian  6/253 (2.4%)1.0 (0.3–4.0)  0.99  19/83 (22.9%)1.0 (0.6–1.8)  0.90
     Black    2/46 (4.4%)  1.9 (0.3–10.8)  0.49    8/21 (38.1%)1.7 (0.9–3.3)  0.13
     HI/PI    0/10 (0%)0 (—)  0.63    6/52 (9.6%)0.4 (0.2–1.1)  0.06
     Hispanic    0/43 (0%)0 (—)  0.31    6/33 (18.2%)0.8 (0.4–1.9)  0.64
     White  3/128 (2.3%)Reference  —  21/95 (22.1%)Reference  —
     Multiple/Other    0/21 (0%)0 (—)  0.48    7/48 (14.6%)0.7 (0.3–1.4)  0.29
    District of residence
     Oahu, Hawaii11/596 (1.9%)Reference  —70/356 (19.7%)Reference  —
     Other island, Hawaii    0/25 (0%)0 (—)  0.49    3/20 (15.0%)0.8 (0.3–2.2)  0.61
     Out of state      2/3 (66.7%)  36.1 (13.4–97.4)<0.01      1/4 (25.0%)1.3 (0.2–7.0)  0.79
    Provider type
     STD clinic  4/241 (1.7%)Reference  —44/225 (19.6%)Reference  —
     Private/HMO  7/292 (2.4%)1.4 (0.4–4.9)  0.55  24/91 (26.4%)1.3 (0.9–2.1)  0.18
     Other    2/91 (2.2%)1.3 (0.2–7.1)  0.74    6/64 (9.4%)0.5 (0.2–1.1)  0.06
    Interviewed patients from STD clinic Sex, sex of sex partner
      MSM    1/62 (1.6%)  1.8 (0.1–27.9)  0.6833/127 (26.0%)2.1 (1.0–4.3)  0.03
      MSW  1/110 (0.9%)Reference  —    8/65 (12.3%)Reference  —
      Women    2/69 (2.9%)  0.3 (0.03–0.4)  0.34    2/27 (7.4%)1.7 (0.4–7.3)  0.50
     Recent travel (patient or partner)
      Yes    2/95 (2.1%)  0.13  16/83 (19.3%)0.9 (0.5–1.6)  0.78
      No  0/110 (0%)Reference  —23/110 (20.9%)Reference  —
     Recent antimicrobial use
      Yes    1/29 (3.5%)  2.4 (0.3–22.1)  0.44    3/11 (27.3%)1.3 (0.5–3.7)  0.57
      No  3/207 (1.5%)Reference  —39/193 (20.2%)Reference  —
     Sex worker (patient or partner)
      Yes    1/21 (4.8%)  4.9 (0.5–52.1)  0.15    0/10 (0%)0 (—)  0.10
      No  2/207 (1.0%)Reference  —41/192 (21.4%)Reference  —
     Military (patient or partner)
      Yes    1/54 (1.9%)  1.6 (0.2–17.7)  0.68  11/39 (28.2%)1.5 (0.8–2.6)  0.22
      No  2/177 (1.1%)Reference  —31/161 (19.3%)Reference  —
    Total13/624 (2.1%)74/380 (19.5%)
    Data presented are number of cases with elevated cefixime MIC/number of patients for whom data were available.
    *There was no cefixime testing, July 2004 to December 2009.
    Analysis restricted to interviewed patients from the STD clinic (n = 241 [172 male patients] for 2003–2004, n = 225 [198 male patients] for 2010–2011).
    HI/PI indicates Hawaiian/Pacific Islander; HMO, Health Maintenance Organization.
    Full article at: http://ht.ly/SOQYs

    By: Sarah Kidd, MD, MPH,* Maria V.C. Lee, MS, Eloisa Maningas, BSMT, Alan Komeya, MPH, Gail Kunimoto, BS,Norman O’Connor, MA, Alan R. Katz, MD, MPH, Glenn M. Wasserman, MD, MPH, Robert D. Kirkcaldy, MD, MPH,* and A. Christian Whelen, PhD

    *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
    Hawaii State Department of Health, Honolulu, HI
    University of Hawaii-Manoa, Honolulu, HI