Men In Urban Areas Research Articles

Men’s involvement in family planning programs: an exploratory study from Karachi, Pakistan

BackgroundIn Pakistan, family planning has traditionally been perceived as primarily a women’s concern, resulting in the exclusion of men from relevant initiatives. This situation is further exacerbated by cultural and social barriers that hinder men’s access to family planning services. This study addresses a significant research gap by assessing the extent of family planning service provision for men in urban areas of Karachi. It delves into the exploration of men’s involvement in family planning service delivery, identifies existing gaps in services catering to men, records men’s perceptions of accessibility and acceptability of these services, and ultimately offers recommendations to enhance men’s involvement and strengthen service provision to better meet their needs.MethodsWe employed a qualitative exploratory research design using semi-structured interviews to investigate perceptions regarding family planning service provision to men. This approach involved 25 interviews, comprising eight key informant interviews with stakeholders, eight with service providers, and nine in-depth interviews with married men.ResultsThis study highlights the limited engagement of men in family planning programs, primarily due to entrenched sociocultural norms that confine female healthcare providers to serving women, hindering men’s involvement. While national and provincial policies endorse men’s participation, they lack defined roles for male providers. Behavioral and information-sharing barriers at the community level discourage male healthcare providers from collaborating with females. Family planning programs, except for NGO-led vasectomy projects, fail to adequately address men’s needs. Despite policy recognition, implementation remains inadequate. Bridging the men’s involvement gap necessitates more male providers and improved contraceptive stigma combat training. Further research is vital to explore effective methods for involving men in community and service delivery in family planning.ConclusionThere is a need to change the perception that contraception is solely the responsibility of women, as men’s participation in family planning in Karachi is limited. Engaging men can yield positive health and non-health outcomes. Culturally sensitive services, developed with community input using a couple-centered approach, are crucial for equitable family planning. Further research is needed to explore men’s inclusion strategies in service provision and utilization.

Time Trends and Geographic Patterns of Mortality Due to Tracheal, Bronchus, and Lung Cancer in Portugal

Tracheal, bronchus, and lung cancer (TBLC) remains a major public health concern. Knowledge about geographic patterns and time trends in TBLC could give insights to better address this problem. This study aimed to evaluate the geographic patterns and time trends in mortality due to TBLC observed in Portugal. TBLC-related deaths and population estimates (2011–2021) were derived from the Instituto Nacional de Estatística. Age-standardized mortality rates for people aged 50 or more (ASMR_50+) per 100,000 were obtained. Analyses were stratified by gender, geographic region, and level of urbanization. The time trends in ASMR_50+ were evaluated using joinpoint regression models, and the values for the annual percentage change (APC) and the respective 95% confidence interval (95% CI) were obtained. Differences in mortality due to TBLC between regions and levels of urbanization (2017–2021) were assessed through a standardized mortality ratio (SMR) and the respective 95% CI. In 2021, the ASMR_50+ per 100,000 inhabitants observed in mainland Portugal was 158.0 and 40.4 among men and women, respectively. According to the time-trend analysis, ASMR_50+ due to TBLC remained stable or described a downward trend among men, but there was an upward trend among women in suburban and urban regions. Observed deaths were significantly higher than the expected for men in urban areas (SMR = 125%; 95% CI: 121–128 and SMR = 118%; 95% CI: 115–122 in Norte and Lisboa, respectively), and women in Urban Norte (SMR = 125%; 95%CI: 119–131). Lower mortality than expected was observed among men living in Rural Norte and Rural Centro, as well as, among women living in all the rural areas. In suburban areas, the observed deaths were lower, higher, or as expected depending on the geographic region and gender. A notable upward trend in mortality due to TBLC among women was observed. The geographic patterns observed suggest the effects of deleterious environmental factors and smoking habits, deserving attention from policymakers.

Accelerometer-Based Estimates of Physical Activity and Sedentary Time Among Samoan Adults.

The prevalence of obesity-related cardiometabolic disease in Samoa is among the highest globally. While physical activity is a modifiable risk factor for obesity-related disease, little is known about physical activity levels among adult Samoans. Using wrist-worn accelerometer-based devices, this study aimed to characterize physical activity among Samoan adults. Samoan adults (n = 385; 55% female, mean [SD] age 52 [10] y) wore Actigraph GT3X+ devices for 7 to 10days. General linear models were used to examine mean daily minutes of sedentary time, light physical activity, and moderate to vigorous physical activity by various participant characteristics. Time spent in moderate to vigorous physical activity did not differ statistically between men (88 [5]min; 95% confidence interval [CI], 80-97) and women (78 [4]min; 95% CI, 70-86; P = .08). Women, however, spent more time than men in light physical activity: 380 (7)minutes (95% CI, 367-393) versus 344 (7)minutes (95% CI, 329-358; P < .001). While there were no differences in physical activity by census region, education, or occupation among women, men in urban areas spent significantly less time in moderate to vigorous physical activity than those in peri-urban and rural areas (P = .015). Women with class II/III obesity spent more time in sedentary activities than those with healthy weight or overweight/class I obesity (P = .048). This study characterizes physical activity among Samoan adults and highlights variation by sex, urbanicity, and weight status. In providing initial device-measured estimates of physical activity in Samoa, this analysis establishes a baseline from which the success of future attempts to intervene on physical activity may be assessed.

The effect of NAFTA on Mexico's wage gap

This paper studies how the North American Free Trade Agreement (NAFTA) affected the wage gap between high and low-paid workers within Mexico, considering internal migration. In low-skilled, labor-abundant developing countries, trade liberalization should theoretically increase the wages of low-skilled workers, decreasing income inequality. However, anecdotal evidence indicates that NAFTA increased the gap between rich and poor in Mexico, and empirical evidence is mixed (Hirte et al. 2020; Brülhart 2011; Bosch and Manacorda 2010; Nicita 2009; Chiquiar 2008; Hanson 2007; Gonzalez-Rivas 2007). Because trade may affect wages differently across regions within the country, accurate measures of wage effects must incorporate internal migration; otherwise, apparent wage convergence or divergence might only reflect a geographic resorting of workers. We evaluate wage changes by considering rural-to-urban migration. We first find a slight decrease in both internal and external migration in the years after NAFTA. Then, we find that all male workers see a wage reduction from trade openness, although the harm of high-wage workers almost doubled that of their counterparts with low wages. NAFTA also mitigated some of the wage differentials between the North and South. In summary, trade liberalization has reduced wage differentials among working-age men in urban areas.

Predictors of Multimorbidity (Defined as Diabetes + Hypertension) Amongst Males Aged 15-54 in India: An Urban/Rural Split Analysis.

Objectives: This study aimed to determine which sociodemographic and lifestyle factors may act as predictors of multimorbidity (defined as diabetes + hypertension) amongst men aged 15-54 within urban and rural areas of India. Methods: Data from the latest 2019-2021 India NFHS-5 survey were utilized. Presumed cases of multimorbidity were defined as men who had DM + HTN. A total of 22,411 men in urban areas and 66,768 rural men were analyzed using mixed-effect multi-level binary logistic regression models. Results: Various predictors were found to have a statistically significant association to multimorbidity. Urban areas: Age, region of residence, wealth, religion, occupation, and BMI. Rural areas: Age, education, region of residence, wealth, occupation, caste, BMI, alcohol consumption, media exposure, and tobacco consumption. Conclusion: Departing from the broad operational definitions often studied within literature, this study provided insight into one of the most prevalent specific multimorbidities across India. The urban/rural split analyses revealed substantial differences in high-risk characteristics across both areas, which have commonly been overlooked. These findings may better inform policymakers and assist in effectively reducing multimorbidity-related burden through area-specific preventative programs.

Incidence of sudden cardiac death among diseases of the circulatory system during the COVID-19 pandemic in the Penza region

To study the incidence of sudden cardiac death (SCD) among overall and primary morbidity of diseases of the circulatory system (DCS) during the COVID-19 pandemic, as well as several years before it in urban and rural populations of the Penza region. Statistical analysis of data using correlation (Pearson's coefficient), regression methods, t-test was performed to determine the significance of results. The higher incidence of DCS among men in urban areas has been found. COVID-19 morbidity did not cause an increase in the incidence of SCD in the rural population in comparison with primary DCS morbidity, which was strongly correlated with the prevalence of novel coronavirus infection.

Exposure to mass media family planning messages among men in Nigeria: analysis of the Demographic and Health Survey data.

Family planning (FP) is essential for improving health and achieving reproductive goals. Although men are important participants in FP decision-making within households in Nigeria, a country with one of the highest rates of maternal mortality, we know very little about their exposure to mass media FP messages. Drawing theoretical insights from the structural influence model of health communication and using the 2018 Nigeria Demographic and Health Survey (n=13,294), and applying logistic regression analysis, we explored the factors associated with men's exposure to mass media FP messages in Nigeria. A range of socioeconomic, locational, and demographic factors were associated with men's exposure to mass media FP messages. For example, wealthier, more educated, and employed men were more likely to be exposed to mass media FP messages than their poorer, less educated, and unemployed counterparts. In addition, compared to those in rural areas and other regions, men in urban areas as well as South East Region, were more likely to be exposed to mass media FP messages. Finally, younger men and those who belong to the traditional religion were less likely to be exposed to mass media FP messages, compared to their older and Christian counterparts. Based on these findings, we discuss implications and recommendations for policymakers as well as directions for future research.

Structural transformation and the gender pay gap in Sub-Saharan Africa.

The focus of this study is the implications of structural transformation for gender equality, specifically equal pay, in Sub-Saharan Africa. While structural transformation affects key development outcomes, including growth, poverty, and access to decent work, its effect on the gender pay gap is not clear ex-ante. Evidence on the gender pay gap in sub-Saharan Africa is limited, and often excludes rural areas and informal (self-)employment. This paper provides evidence on the extent and drivers of the gender pay gap in non-farm wage- and self-employment activities across three countries at different stages of structural transformation (Malawi, Tanzania and Nigeria). The analysis leverages nationally-representative survey data and decomposition methods, and is conducted separately among individuals residing in rural versus urban areas in each country. The results show that women earn 40 to 46 percent less than men in urban areas, which is substantially less than in high-income countries. The gender pay gap in rural areas ranges from (a statistically insignificant) 12 percent in Tanzania to 77 percent in Nigeria. In all rural areas, a major share of the gender pay gap (81 percent in Malawi, 83 percent in Tanzania and 70 percent in Nigeria) is explained by differences in workers' characteristics, including education, occupation and sector. This suggests that if rural men and women had similar characteristics, most of the gender pay gap would disappear. Country-differences are larger across urban areas, where differences in characteristics account for only 32 percent of the pay gap in Tanzania, 50 percent in Malawi and 81 percent in Nigeria. Our detailed decomposition results suggest that structural transformation does not consistently help bridge the gender pay gap. Gender-sensitive policies are required to ensure equal pay for men and women.

“Africa's First Woman Press Photographer”: Mabel Cetu's Photographs in Zonk!

“Africa's First Woman Press Photographer”: Mabel Cetu's Photographs in <i>Zonk!</i>

Outcomes of 75 consecutive cases of laparoscopic one-anastomosis gastric bypass: A prospective study

Background: Obesity is increasing at an alarming rate in India along with rest of the world. In the National Family and Health survey - IV conducted in 2015-16; 31.3% women and 26.6% men in urban area were obese or over weight. Bariatric surgery has long been introduced for weight control and is well established measure and superior to other weight control measures. Procedures like laparoscopic Roux en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are more commonly performed than Laparoscopic One Anastomosis Gastric Bypass (LOAGB). Although sufficient data has accumulated in literature regarding the safety and efficacy of LOAGB, some of standard textbooks still mention it as an experimental procedure and not the mainstream procedure. Aims and Objective: The present study was conducted with objective to find out changes in pre-operative and post-operative status of diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnoea, osteoarthritis, GERD and quality of life after laparoscopic one anastomosis gastric bypass along with its safety and efficacy in Indian population. Material and Methods: The study was conducted at a tertiary care bariatric surgical centre and included 75 consecutive individual operated between January 2016 to December 2017 who underwent Laparoscopic One Anastomosis Gastric Bypass and followed prospectively for minimum 1 year (mean 18 months) and statistical analysis was done using SPSS 21 software. Result: One Anastomosis Gastric Bypass was completed laparoscopically in all the patients without need for conversion to an open procedure. The overall complication with Laparoscopic One Anastomosis Gastric Bypass was 1.3% without any mortality. Mean percentage of excess weight loss (% EWL) achieved was 72.73. 93.9 % patients with diabetes, 67.43% patients with hypertension, 87.1% patient with hyperlipidemia, all the patient with obstructive sleep apnoea and osteoarthritis of knee showed improvement in their disease status. None of the patient showed worsening of gastroesophageal reflux or development of new symptoms of gastro esophageal reflux. All patients had improvement in their quality of life as seen in the improvement of their SF 36 scores. Conclusion: Laparoscopic One Anastomosis Gastric Bypass is a safe and effective bariatric procedure. The post procedure improvement in diabetes, hypertension, hyperlipidemia, obstructive sleep apnoea, osteoarthritis of knee and quality of life is significant in Indian context.

Vision-specific risk factors impacting self-rated health among older men in urban China: a population-based cross-sectional study

BackgroundSelf-rated health (SRH) has been well documented as an important assessment of health status among the older adults. Interestingly, visual ability has been reported to have a considerable impact on...

The Case Study of Heart Disease at Urban and Rural Communities by Gender and Age in Indonesia in 2018

Introduction: Heart disease is a community health problem. It is expensive to care and cure and leadingcause of death in Indonesia. The research aimed to analyze relationship and magnitude of the risk ofexposure of heart disease in urban and rural communities according to age and sex factors. Methods: Itwas quantitative research with cross sectional design. Data came from Indonesia Basic Health Researchat 2018 with all household as population. Sample were individuals aged ≥ 15 years. It used chi squareand estimate risk analysis. Results: Heart disease was higher in urban areas, especially 54,6% womenwere more exposed to heart disease than 45,4% men. Also elderly group was the highest (65,8%) thanother group. There were 66.7% elderly men and 65.0% women risk to exposed heart disease than othergroups. There was a significant relationship between gender, age and region with heart disease cases.The exposure risk of heart disease for men in urban areas were 1.4 times greater than rural. The urbanelderly group were 1.9 times greater than rural. The urban elderly men group were 2 times greater thanrural. The urban elderly women group were 1.8 times larger than rural. Conclusion: Heart disease inurban areas was higher than rural areas. Women had more risk of heart disease. Elderly women grouphad highest risk than other age groups.

Predictors of Knowledge and Perception of Family Planning among Men in Urban Areas in Northwest Nigeria

Introduction: The use of family planning (FP) methods has remained low in Nigeria despite the high fertility rate and unmet need; partly because men are excluded in FP programs. Most studies on FP were carried out among married women and information about men was acquired from their wives. Unfortunately, such information may not be accurate. Aims: The study aimed to determine the predictors of FP knowledge and perception among men in urban areas in the Northwestern part of Nigeria. Subjects and Methods: The study was cross-sectional in design, carried out in urban areas in Northwest Nigeria among 167 married men in November 2017 enrolled through a multi-stage sampling technique. Data collection was done with a structured questionnaire which was interviewer-administered. SPSS version 23 was used to analyze the data. Results: The majority (75, 45.5%) had poor knowledge of FP and 118 (71.5%) had a positive perception of FP. Social class (adjusted odds ratio [aOR]: 15.75, 95% confidence interval [CI] = 2.14–116.03) and perception (aOR: 0.13, 95% CI = 0.03–0.59) were the predictors of good FP knowledge while knowledge (aOR = 0.10, CI: 0.02–0.51) predicted positive perception on FP. Conclusion: Knowledge of FP was poor; the perception of the majority was positive. There is a need by the Sokoto State Government, Local Government Areas, and religious leaders to increase information on FP, especially on the benefits and methods, and the need for males to participate in FP through the enlightenment of the public using the media, schools, and worship places.

The Relationship between External and Internal Risk Factors with Pulmonary Tuberculosis in Children Aged 0-59 Months in Slums in Indonesia, 2013

BACKGROUND: Tuberculosis (Tb) remains a health problem throughout the world. World Health Organization (WHO) has set it as a &amp;ldquo;Global Emergency&amp;rdquo; disease. The difficulty of confirming the diagnosis of it in children, different from it in adults, causes the treatment of it in children often neglected. This problem is exacerbated by the supporting environmental conditions, namely living in slums, which makes the risk of transmission even higher.&#x0D; &#x0D; OBJECTIVE: To identify internal and external factors related to Tb in children aged 0-59 months living in slums in Indonesia.&#x0D; &#x0D; MATERIAL &amp;amp; METHOD: The data source used was the 2013 Basic Health Research (Riskesdas) using a sample of children less than five years old who lived in slums in 34 provinces in Indonesia. &#x0D; &#x0D; RESULTS: Logistic regression analysis found three risk factors, namely BCG immunization status (age-based), at-risk home environment, and gender (residential area-based). Vaccinated children under one year of age have the best probability of not suffering from pulmonary tuberculosis. Those who live in a house inhabited by less than five people, or in that occupied by more than four with no one of which smokes or does not suffer from pulmonary tuberculosis has a probability of not being exposed to it. Likewise, women who live in rural areas have almost two times less probability of suffering from it, compared to men in urban areas. &#x0D; &#x0D; CONCLUSION: Factors contributing to the prevalence of pulmonary tuberculosis in infants in slums are the status of BCG immunization, air cleanliness in the neighborhood, which can be seen from the differences of risks in rural and urban, and the number of inhabitants per house and their behavior.

Disparities in prevalence of metabolic syndrome: A cross-sectional analysis of Indian adults

Abstract Background Metabolic syndrome (MS) is a cluster of risk factors: central obesity, a low level of high-density lipoprotein cholesterol, high levels of triglyceride, fasting glucose, and blood pressure. Individuals with MS have an increased risk for cardiovascular disease and diabetes. South Asians, including Indians, generally have higher rates, earlier onset, and severe forms of cardiovascular diseases and the associated risk factors compared to other ethnic groups. This study assessed the prevalence of MS in an adult South Indian population, and further examined socioeconomic, gender and rurality disparities. Methods We analyzed data from 7,697 adults aged between 20 and 76 years participating in the baseline PURSE-HIS study, a community-based cross-sectional study conducted in India in 2012. Socioeconomic status was derived from summary scores of three variables: family income, education and occupation. Univariate and multivariate logistic regressions were conducted to find the association between behavioral risk factors and metabolic syndrome, after adjusting for age, sex, rurality and socioeconomic status. Results The overall prevalence of metabolic syndrome was 36.3%, with significant gender difference (38.3% for women vs. 33.8% for men, P &amp;lt; 0.01). Women in semi-urban areas were twice as likely to have metabolic syndrome compared to men in urban areas (OR = 2.0, 95%CI:1.2 to 3.1, p &amp;lt; 0.01). Women in higher socioeconomic group were more than four times likely to have metabolic syndrome compared to men in lower socioeconomic group (OR = 4.2, 95%CI:2.3 to 7.6, p &amp;lt; 0.01). Conclusions The study emphasizes the need of preventative and curative interventions focused on low-socioeconomic populations, particularly women who reside in non-urban areas. The findings have important implications for the USA because there are 2.4 million foreign-born population from India, making it the second-largest immigrant group in the USA after Mexicans. Key messages Low socioeconmic population and women residing in non-urban areas are at higher risk for metabolic syndrome. Preventative and curative interventions focused on low-socioeconomic populations should be prioritized.

Drugs, Guns, and Disadvantaged Youths: Co-occurring Behavior and the Code of the Street

Guided by Anderson’s theory of the code of the street, this study explored social mechanisms linking individual-level disadvantage factors with the adoption of beliefs grounded in the code of the street and with drug trafficking and gun carrying—the co-occurring behavior shaping violence among young men in urban areas. Secondary data were employed from a sample of male inmates and a sample of male high school students. Data analysis indicated that the social disadvantage factor absent father significantly predicted this co-occurring behavior in the inmate sample, whereas the social disadvantage factor history of expulsion did so in the student sample. In both samples, race and adopting beliefs about gun carrying from the code of the street were significant predictors of drug trafficking and gun carrying. The results do not suggest that such code-based beliefs’ impact on drug trafficking and gun carrying differs by race. Implications for social policy are discussed.

Gender Differentials in One-Person Households among Older Adults in India: Evidence from the National Family Health Survey 2015–2016

The present study analyses various aspects of one-person households (OPH) among older adults from multiple socioeconomic backgrounds in India. The study utilizes data from the National Family Health Survey conducted in 2015–2016 (N = 146,657), and employs bivariate and binary logistic regression analysis to carve out the results. The percent OPH among older adults in India was 7.4% (2.4% men and 28% women). In terms of gender differentials, it was found that older women were more likely to stay in OPH than older men. The interaction of marital status with gender and place of residence together revealed that married women in rural areas were significantly more likely to stay in OPH than widowed men in urban areas. There is an urgent need to strengthen the social security scheme for older adults in OPH in India, especially in the southern part of the country, where the prevalence of OPH is the highest.

Hubungan kadar testosteron serum dengan kekuatan genggaman pada lanjut usia laki-laki

Background: Many elder peoples in the community suffering from frailty syndrome and sarcopenia. One of the important components in the occurrence of frailty and sarcopenia is the decrease in muscle strength that can withstand grip strength. Various factors influence, one of which is the level of testosterone hormone. There are still some controversial results regarding the relationship between testosterone levels and hand grip strength. Objective: This study aimed to prove that testosterone levels are associated with grip strength in elderly men. Methods: This study is an analytic cross-sectional study in an urban area in Bali. The study was started by giving informed consent to the research subjects, then examination using a handgrip dynamometer, and taking blood samples to check testosterone levels. The relationship between testosterone levels and grip strength was analyzed using the Spearman test using SPSS edition 24 software. Results: A total of 62 elderly men in urban areas in Bali were involved in this study. The mean age was 69,26 years old. The subjects' comorbid diseases were assessed by a CACI score with a mean score of 2,87. The mean value of testosterone levels was 421,79 ng / mL with a minimum value of serum testosterone levels of 0,05 ng / ml, a maximum value of 12,63 ng / ml. It was proven that there was a significant relationship between testosterone levels and grip strength in elderly men (p = 0.031, r = 0,274). Conclusion: Testosterone levels associated with hand grip strength in elderly man.

India's Missing Working Women: Tracing the Journey of Women's Economic Contribution Over the Last Seven Decades

India, today, is an economic powerhouse on the global stage, however, it faces a queer conundrum – despite considerable gains in female education, decreases in fertility rates, and increasing economic growth, only a quarter of its women are in the labor force – amongst the lowest in the world. Based on analysis of time series data over the last five decades (1970-2018), this paper finds that women’s labor force and workforce participation rates have declined to their lowest levels since Independence. Women’s average wages have consistently remained below that of men. The fall in labor force participation has been led by women in rural areas, while female unemployment rates have remained higher than men in urban areas. A high proportion of working women are in casual employment. Occupational segregation and concentration of women in low growth sectors, income effect of rising household-incomes, increased mechanization and automation are leading factors giving rise to these trends. The persistent notion that women’s primary responsibility lies in domestic duties, manifests in them being viewed as second income earners, lacking family and institutional support. In the absence of targeted policy interventions to support workforce participation, women are likely to continue being excluded from India’s spectacular growth story.

Evidence of interventions for improving healthcare access for lesbian, gay, bisexual and transgender people in South Africa: A scoping review.

BackgroundThe lesbian, gay, bisexual and transgender (LGBT) populations have unique health risks including an increased risk of mental health problems, high usage of recreational drugs and alcohol, and high rates of infection with human immunodeficiency virus (HIV). Healthcare workers’ heteronormative attitudes compromise the quality of care to the LGBT population.AimThe objective of this study was to provide an overview of documented evidence on South Africa interventions aimed at improving healthcare access for LGBT individuals using a systematic scoping review.SettingThis is a secondary literature review.MethodsAn electronic search was conducted using the following databases: EBSCOhost, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. and full article data were screened using inclusion and exclusion criteria by two researchers. Data extracted from the eligible studies were analysed using thematic analysis. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool, version 2011.ResultsSeventeen articles of the initial 151 hits were selected for review and an additional five files were identified through bibliographical search. Most studies had small sample sizes and focused on sexual health, targeting gay men and men who have sex with men in urban areas. Lesbians and bisexual women were not prioritised.DiscussionIt emerged from the review that LGBT issues were not covered in the healthcare worker curriculum. Further it was noted that there is a paucity of data on the South African LGBT population, as sexual orientation does not form part of the routine data set. The findings of this review indicate gaps in the literature, practice guidelines and policies in LGBT healthcare in South Africa.