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Paper [clear filter]
Sunday, March 8
 

8:30am

Addressing the needs of women survivors of child abuse: The ethical, socio-political and professional imperative of trauma-informed care
Interpersonal trauma has a broad range of physical, social and mental health consequences, which poses a heavy and largely unrecognized burden on our healthcare, social service and criminal justice systems. Interpersonal trauma experienced in childhood has especially pernicious consequences. In this paper, we address the problem that traumatized women are vulnerable to receiving suboptimal healthcare and social services especially when they have a history of chronic traumatization, such as childhood sexual, physical or emotional abuse or neglect. To remedy this, our healthcare and social service systems must deliver trauma-informed care. Although there is a growing recognition of the need for trauma-informed care within healthcare and social services, there continues to be an under-recognition and lack of appropriate care for trauma survivors. Without the requisite knowledge, providers cannot practice in a professionally competent way and cannot provide adequate client-centered care because care needed may never be provided and "care" provided may be neither effective nor efficient. Drawing on feminist philosopher, Iris Young’s social connection model that explicates that certain suffering is socially caused, we argue that providing trauma-informed care is an ethical, socio-political and professional imperative. We also argue that trauma-informed care is a form of restorative justice by providing opportunities for women trauma survivors to receive the care they need and, in the process, have a reparative experience of validation and empowerment. While clinicians and professional bodies have a special responsibility to increase trauma recognition and response in all aspects of care for trauma survivors, we will argue that there is also a broader ethical and socio-political imperative to share this responsibility. The responsibility to ensure that trauma-informed care is provided extends beyond individual practitioners, relevant health professions and health systems to citizens, governments and global health and human rights initiatives. Our collective “responsibility for justice”—best understood through Iris Young’s “social connection model”—is what’s required.


Sunday March 8, 2015 8:30am - 9:45am
Washington

8:30am

Risks of Commercialized Science: Antidepressants, PMDD, and Big Pharma
The American Psychiatric Association (2013) officially added Premenstrual Dysphoric Disorder (PMDD) as a mood disorder in the DSM-5, despite controversy over its validity, the lack of research in marginalized populations (Pilver et al., 2011), and concerns that PMDD pathologizes normal experience and disregards contextual factors of emotional distress (Ussher, 2012). However, the pharmaceutical industry has much to gain by legitimizing PMDD as a disorder and promoting the need for antidepressant medication (ADM) to treat it. The repackaging of Prozac/fluoxetine as Sarafem as a “new and effective” treatment was certainly helped by the financial relationships among industry, the APA, DSM, and FDA; the majority of DSM-IV PMDD panel members had industry ties, and the expert opinion given to the FDA by a DSM panel member that PMDD was a ‘real and distinct’ disorder was instrumental in getting Sarafem/Prozac approved (Cosgrove & Wheeler, 2013). There are currently three ADMs approved to treat PMDD and the industry-facilitated approval of these drugs was used to justify PMDD’s inclusion in the DSM-5. In a previous investigation, we found two meta-analyses of randomized clinical trials (RCTs) of ADM for PMDD that came to different conclusions about efficacy—even though they reviewed the same evidence. The meta-analysis authored by researchers with commercial ties concluded that ADMs are effective (Shah et al, 2008). The authors of the other meta-analysis who did not have industry ties concluded that current evidence about efficacy is unsatisfactory (Kleinstäuber, 2012). In this presentation, we will provide data on the extent and type of industry support of RCTs of ADM for PMDD, discuss the relationship between industry funding and the conclusions drawn about the efficacy and safety of ADM for the treatment of PMDD, and examine how marginalized populations are represented in RCTs. Prescriptions for reform and implications for stakeholders will also be addressed. References American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Publishing. Cosgrove, L., & Wheeler, E. E. (2013). Industry’s colonization of psychiatry: Ethical and practical implications of financial conflicts of interest in the DSM-5. Feminism & Psychology, 23(1), 93-106. Kleinstäuber M., Witthöft M., & Hiller W. (2012) Cognitive-Behavioral and pharmacological interventions for premenstrual syndrome or premenstrual dysphoric disorder: A meta-analysis. Journal of Clinical Psychology in Medical Settings, 19, 308-319. Pilver C. E., Desai, R., Kasi, S., & Levy, B. R. (2011). Lifetime discrimination associated with greater likelihood of premenstrual dysphoric disorder. Journal of Women’s Health, 20(6), 923-931. Shah, N. R., Jones, J. B., Aperi, J., Shemtov, R., Karne, A., Borenstein, J. (2008). Selective serotonin reuptake inhibitors for premenstrual dysphoric disorder: A meta-analysis. Obstetrics & Gynecology, 111(5), 1175-1182. Ussher, J. M. (2012). Diagnosing difficult women and pathologising femininity: Gender bias in psychiatric nosology. Feminism & Psychology, 23(1), 63-69.

Speakers
MB

Madeline Brodt

University of Massachusetts Boston
LC

Lisa Cosgrove

University of Massachusetts Boston
SP

Shannon Peters

University of Massachusetts Boston


Sunday March 8, 2015 8:30am - 9:45am
Washington

8:30am

“I am not a man”: Disaggregating transgender women from MSM in PrEP research is imperative to improve HIV prevention efforts
Transgender women (‘transwomen’) are at disproportionate risk of acquiring HIV. Pre-exposure prophylaxis (PrEP) represents the first efficacious biomedical HIV prevention approach. However, a subanalysis of the iPrEx data revealed zero efficacy among transwomen in the trial. Furthermore, transwomen are excluded or underrepresented in PrEP research, often aggregated with MSM without consideration for their unique positions within sociocultural contexts. This study examined culturally specific facilitators and barriers to PrEP acceptability among urban transwomen at risk for HIV. We conducted 3 focus groups and 9 individual interviews with transwomen (total N=30) in San Francisco focused on their knowledge of, interest in, and concerns about PrEP for HIV prevention. Transcripts were analyzed for common themes; a team of researchers applied analytic codes using Atlas.ti. Due to negative experiences with healthcare providers and healthcare settings, ability to obtain PrEP from a trans-friendly provider (particularly the same trusted provider that prescribes their hormones) was cited as essential to PrEP uptake and adherence. While knowledge of PrEP was low, interest was relatively high. Participants noted that use of PrEP could address several aspects of transwomen’s lives that increase their HIV risk, including sex work and low power to negotiate safer sex. Barriers to PrEP use included concerns about interactions with hormones, managing multiple medications, potential side effects, and avoidance of medical settings. Findings underscore an urgent need to disaggregate transwomen from MSM in HIV prevention strategies, emphasizing several trans-specific facilitators and concerns to inform dissemination of PrEP among urban transwomen. Ongoing failure to consider positions of transwomen’s bodies and sexualities within fraught sociocultural contexts, including medical settings, has limited the effectiveness of HIV prevention efforts to mitigate disparate risk among this highly vulnerable and unique group.


Sunday March 8, 2015 8:30am - 9:45am
Washington