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Axel Foster
Axel Foster

Oxford Handbook Of General Practice Pdf 11

Moreover, it had also helped the junior doctors in the practice revision within elusive topics needed for the preparation. Therefore, the clinical specialties pdf comes with its 11 edition. The feature of the 11th edition handbook has designed to ease the learning and be true to humanity

oxford handbook of general practice pdf 11

Ideally, we want to interrupt the process prior to the application of stigma. Thus, interventions often target the removal of the drivers of stigma or the shifting of norms and policies that facilitate the stigmatization process [33]. However, once a stigma is applied to people with a specific disease or health condition and once it manifests in experiences or practices, interventions are needed to mitigate harm and shift harmful attitudes and behaviors that compromise the general health and wellbeing of affected communities. Stigma-reduction interventions are most effective when they include components directed at a range of actors and socio-ecological levels [37]. A multi-component intervention, for example, may seek to support individuals with leprosy to cope with experienced stigma and overcome internalized stigma, as well as reaching out to community members to shift harmful norms about leprosy through community dialogues or engaging local leaders to share anti-stigma messages [48]. Likewise, advocacy with policy-makers and community leaders about the benefits of syringe exchange programs to prevent transmission of HIV may be combined with training of law enforcement officers on harm reduction and proper implementation of laws that de-criminalize drug use [49].

The availability of data on health-related stigma and discrimination is critical for improving interventions and programs to address them, yet such routine data are often lacking [33]. The Health Stigma and Discrimination Framework indicates key areas of focus for program-, facility-, and national-level monitoring. At the program level, data on the drivers and facilitators of stigma are needed to inform appropriate interventions in a given context. Systematically collected information regarding the manifestations of stigma is required for researchers and program evaluators to assess the impact of interventions to reduce stigma or mitigate the related harmful consequences. Such information is also important for health facility administrators to identify when training or changes to institutional policies are required to ensure a stigma-free healthcare environment. Affected communities and advocates can use information on stigmatizing practices, as well as the experiences and realities of affected individuals, to raise awareness among the general population and policy-makers to facilitate change. At the national level, data on the outcomes of stigma for affected populations and for organizations and institutions is needed to inform funding for and the scale of programming to address health-related stigma. Such information will also help to identify gaps where new interventions or programs are required.

PLHIV, including adolescents and young people, report a range of stigmatizing experiences from others, including social rejection, exclusion, gossip, and poor healthcare, and are at risk of internalizing stigma [110]. The level of HIV stigma in communities and societies influences a number of stigma practices, such as discriminatory attitudes among the general public and healthcare workers, and harmful stereotypes and prejudices that can lead to stigmatizing behavior towards PLHIV (exclusion, verbal abuse, etc.). Outcomes of HIV stigma for people at risk of or living with HIV include engagement in greater HIV risk behaviors, lower rates of HIV testing, worse engagement and retention in HIV care, and worse initiation and adherence to medication [3, 44, 111]. Institutional outcomes include stigmatizing policies such as those that criminalize PLHIV who do not disclose their HIV status to their partners or prohibit PLHIV from traveling. Finally, HIV-related stigma has downstream effects on HIV incidence as well as morbidity, mortality, and quality of life for PLHIV [3, 109].


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