Kristefer Stojanovski

Tulane University | TU · School of Public Health and Tropical Medicine

Background Lesbian, gay, bisexual men, and transgender persons (LGBT) in Kenya and Rwanda have a hard time accessing healthcare, in particular sexual health screening. We used a social norms and values framework to examine determinants of access to healthcare, with specific attention to sexual healthcare. Methods We draw on cross-sectional mixed m...

Background Globally lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons experience stigma across at multiple socioecological levels with health-harming impacts. The objectives of this study were to quantify and explore how stigma shapes mental health among LGBTQ+ persons living in Rwanda and Kenya. Methods Respondent-driven sampling wa...

Introduction The multidimensionality of stigma that LGBT people experience globally necessitates research to explore the processes at work. The study aimed to quantify the level of othering and explore the process of LGBT othering in Rwanda. Methods We conducted a sequential cross-sectional mixed-methods study of LGBT lived experiences in Rwanda....

Background Sexual and gender minorities (SGM) are “othered” from society. This study quantifies and explores the process of “othering” of SGM Rwandans through the lens of those who “other” and those who experience “othering.” Methods We conducted a mixed methods study surveying 499 & conducting focus groups with 59 SGM. We surveyed 1,254 & conduct...

Background: While much research has addressed mental health concerns related to the coronavirus disease 2019 (COVID-19) pandemic, there remains a scarcity of studies specifically exploring the changes in anxiety and depression among university students before and after the implementation of COVID-19 mitigation measures. Methods: In this systemat...

Purpose of review Global disparities in HIV infection, particularly among gay, bisexual, and other men who have sex with men (GBMSM), indicate the importance of exploring the multi-level processes that shape HIV’s spread. We used Complex Systems Theory and the PRISMA guidelines to conduct a systematic review of 63 global reviews to understand how H...

Structural stigma shapes men who have sex with men’s (MSM’s) mental health and sexual behaviours. The aim of this study was to examine how stigmatizing policies interact with downstream anxiety/depression and sexual behaviours to structurally pattern HIV disparities among European MSM. We conducted a secondary data analysis of the European Men-who-...

The big data revolution presents an exciting frontier to expand public health research, broadening the scope of research and increasing the precision of answers. Despite these advances, scientists must be vigilant against also advancing potential harms toward marginalized communities. In this review, we provide examples in which big data applicatio...

Objectives Public health detailing is an intervention in which a public health professional visits health care providers to educate them about evidence-based approaches to improve health. The San Francisco Department of Public Health conducted a public health detailing program from 2016 to 2018 to improve sexual health care and preexposure prophyla...

The United States (U.S.) has a plan to end the HIV epidemic by 2030. The plan’s first pillar prioritizes HIV testing. Social Network Strategy (SNS) is an intervention to reach persons not routinely testing for HIV. We conducted a systematic review of SNS to understand its implementation to optimize HIV testing in the U.S. among key populations. The...

Objectives. To describe disparities in depression, anxiety, and problem drinking by sexual orientation, sexual behavior, and gender identity during the COVID-19 pandemic. Methods. Data were collected May 21 to July 15, 2020, from 3245 adults living in 5 major US metropolitan areas (Atlanta, Georgia; Chicago, Illinois; New Orleans, Louisiana; New Yo...

Background: In the face of the novel virus SARS-CoV-2, scientists and the public are eager for evidence about what measures are effective at slowing its spread and preventing morbidity and mortality. Other than mathematical modeling, studies thus far evaluating public health and behavioral interventions at scale have largely been observational and...

Purpose: There is a dearth of lesbian gay, bisexual, transgender, and queer (LGBTQ+) mental health research in Southeast Europe. Our study aimed to explore Macedonian LGBTQ+ people's mental health and their experiences with mental health services. Methods: We conducted a qualitative study with 71 LGBTQ persons in N. Macedonia in the summer of 20...

The inequitable and growing prevalence and incidence of HIV in Europe among GBMSM is an enduring characteristic of the HIV epidemic and makes the continent an important geographical region to study from a global health perspective. Stigma is a significant barrier to, or fundamental cause of, limited equity in HIV prevention and treatment. Yet, curr...

Background Men who have sex with men (MSM) in Europe are most affected by HIV disparities. Complex systems theory proposes that many health behaviors and risks arise from numerous cascading and interacting processes. Our aim was to explore how stigmatizing policies at the European country-level create pathways to HIV risk and disparities among MSM...

Sexual and gender minorities (SGM) community practice efforts vary globally. In North Macedonia, we conducted a needs assessment with 71 SGM community members and 11 non-governmental organization (NGO) staff. We used narrative and thematic analysis to assess how participants described SGM social movements, community building, and community practice...

Background: Reasons for unmet health needs vary from individual to contextual determinants but are defined as the difference between needed health service and services actually received. Roma experience elevated health issues and challenging social conditions. Objective: The aim of this study was to explore the unmet health needs and potential risk...

Purpose The purpose of this paper is to explore the emergence of “Roma health and wellbeing” as a focus of attention in European research and in policy and the possible detrimental consequences of action founded on a generic representation of “Roma health” Design/methodology/approach Based on discussions with and research conducted by scholars who...

There exists limited understanding about the intersectional nature of needs and inequities among sexual and gender minorities in Macedonia and Eastern Europe. We conducted a qualitative, cross-sectional and national needs assessment among 71 sexual and gender minority community members using semi-structured focus groups and interviews. Thematic ana...

Upon gaining independence in the early 1990s, the countries of South Eastern Europe (SEE) have embarked on political and economic transformations. SEE is made up of the countries located in the Balkan Peninsula (also commonly referred to as the Western Balkans). This chapter will focus on the following countries: Albania, Bosnia and Herzegovina, Bu...

While sexual and gender minorities (SGM)-based discrimination and poor mental health is well established in the literature within Western contexts, there is a significant gap in our understanding in other regions, specifically Southeastern Europe. Additionally, limited information exists on self-concealment’s role in these pathways. We explored the...

We examined an application of the minority stress model to the experiences of sexual and gender minorities in Macedonia. We conducted a cross-sectional online national survey among 18–30-year-old participants in Macedonia. We facilitated two focus groups with a subset of sexual and gender minority participants to gain an additional context about th...

Objectives: The objective of this research was to determine modern contraceptive use (MCU) and explore factors associated with MCU in the Western Balkans. Methods: Multiple Indicator Cluster Survey (MICS) data from Bosnia and Herzegovina, Kosovo, Macedonia, Montenegro and Serbia, including the datasets from Roma settlements, were merged. Bivariate...

Preexposure prophylaxis is a highly protective HIV prevention strategy, yet nonadherence can significantly reduce its effectiveness. We conducted a mixed methods evaluation of a mobile health intervention (iText) that utilized weekly bidirectional text or e-mail support messages to encourage preexposure prophylaxis (PrEP) adherence among participan...

The conflict in Kosovo created mass displacement and a fractured health system. Roma, Ashkali, and Balkan Egyptian communities are particularly vulnerable to discrimination and exclusion from institutions. We aimed to examine Roma, Ashkali, and Balkan Egyptian disparities in quantity and quality of antenatal care received. We conducted a cross-sect...

Background Roma are Europe’s largest minority population. Serbia and Macedonia have the greatest proportion of Roma outside of the European Union. Our objective was to examine women’s agency and how it related to desired timing of pregnancy among Romani women in Macedonia and Serbia. Methods We surveyed 410 Romani women who had given birth in the l...

Background: Racial discrimination may increase the risk of low birthweight (LBW), but has not been studied among Roma, the largest minority population in Europe. Moreover, few studies test both institutional and interpersonal forms of racial discrimination on health. Our objective was to examine associations between institutional and interpersonal...

Background: The objective of this study was to examine predictors of prenatal smoking, and attempted smoking cessation during pregnancy among Romani women. Methods: A community-based, cross-sectional study (November 2012 to February 2013) of 410 Romani women in Roma settlements in Serbia and Macedonia was conducted. Logistic regression was used...

Scales used to assess discrimination in public health research have rarely been validated outside of high income countries. Our objective was to validate the Experiences of Discrimination (EOD) scale and the Everyday Discrimination Scale (EDS) among 410 Romani women in Macedonia and Serbia. Romani female interviewers conducted interviews in 2012-20...

In Central and Eastern Europe, the progression of rights for lesbian, gay, bisexual, transgender, and queer (LGBTQ) persons has not had the same success as in other parts of the world. The purpose of this study was to examine how society and politics influence men who have sex with men (MSM) and transgender women in Macedonia, particularly in relat...

The Serbian constitution and health-related laws assert that citizens and residents are universally entitled to health care, provided that they hold health insurance. However, until 2010, persons who did not hold a national identification number (ID) were required to present a plethora of documents to be granted one. We assessed the relationship be...

To the Editor—We read with interest the article by Karris et al [1], which describes that although a majority of North American infectious disease physicians (74%) support the provision of human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) to at-risk individuals, strikingly few (9%) had prescribed PrEP. However, there remains a pauci...

Background: Pre-exposure prophylaxis (PrEP) trials using tenofovir-based regimens have demonstrated that high levels of adherence are required to evaluate efficacy; the incorporation of objective biomarkers of adherence in trial design has been essential to interpretation, given the inaccuracy of self-report. Antiretroviral measurements in scalp h...

Full vaccination coverage for children under 59 months of age in Serbia is over 90%. This study assesses vaccination coverage and examines its association with birth registration among Roma children who resided in disadvantaged settlements in Belgrade, Serbia. The First Roma Health and Nutrition Survey in Belgrade settlements, 2009, was conducted a...