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The objective of this study is to understand the linkage between peace processes and transitional justice in armed conflict areas, comparing three experiences from Mindanao (the Philippines), Colombia, and Thailand's Deep South in the implementation of transitional justice (TJ). The study found that the substantial success of conflict transformation in the Mindanao and Colombia peace processes resulted from balancing and emphasizing human rights and peace processes by applying significant transitional justice innovations at the implementation stage. Although the peace processes in Mindanao and Colombia evolved prior to 1996 and 1990, respectively, the peace process in Thailand's Deep South commenced more recently, in 2013. Despite the time differences, this study helps us understand the relevance and importance of peace processes and transitional justice from each country, providing lessons for the progress of the peace process in Thailand's Deep South.

The analysis of an updated monthly climatology of observed temperature and salinity from the U.S. Navy Generalized Digital Environment Model reveals a basin‐scale cyclonic circulation over the deep South China Sea (SCS). The cyclonic circulation lies from about 2400 m to the bottom. The boundary current transport of the cyclonic circulation is around 3.0 Sv. Our results suggest that the cyclonic circulation is mainly forced by the Luzon overflow, with bottom topography playing an important role. The structures of potential temperature, salinity, and potential density in the deep SCS are consistent with the existence of the cyclonic circulation. Specifically, low salinity water is found in the interior region west of Luzon Island, and surrounded by saline Pacific water in boundary current regions to the north, west and southwest. Our results show the potential density distribution and the corresponding cyclonic circulation in deep SCS are primarily controlled by salinity variations in the deep basin.

The South China Sea (SCS) is a large marginal sea connecting the Indian and Pacific oceans. Under the factors of monsoons, strait transport, and varied bathymetry, the SCS presents a three-layer structure and strong diapycnal mixing which is far greater than that in the open ocean. Theoretical analysis and observations reveal that internal tides, internal solitary waves, and strong winds are the sources of the strong mixing in the northern SCS. A major consequence of the strong mixing is an active mid-deep circulation system. This system promotes exchange of water between the SCS and adjacent oceans, and also regulates the upper layer of wind-driven circulation, making the 3 dimensional SCS circulation clearly different from that in other tropical and subtropical marginal seas. The mass transport capacity of the mid-deep circulation has a substantial impact on marine sedimentation, the biogeochemical cycle, and other processes in the SCS. This paper summarizes the recent advances in mid-deep sea circulation dynamics of the SCS, and discusses the opportunities and challenges in this area.

Background Pertussis remains a significant public health concern in Thailand’s southernmost provinces, where low vaccination coverage has contributed to recurring outbreaks. This study aimed to identify high-risk sub-districts and analyze pertussis trends from 2015 to July 2024, accounting for gender-age group variations. Methods We analyzed pertussis surveillance data from four provinces (Songkhla, Pattani, Yala, and Narathiwat) comprising 377 sub-districts. Cases were categorized into five age groups (< 1, 1–4, 5–9, 10–19, and 20 + years) combined with gender to create 10 gender-age groups. Data structure included 30,160 records across 8 years. Using a two-step modeling approach, we applied logistic regression for occurrence analysis and log-linear regression for incidence rates without zero. The results were combined to identify high-risk areas. Results A total of 1,677 pertussis cases were recorded, corresponding to an overall occurrence rate of 5.04%, with median and incidence rate of 6.64 and 13.53 per 1,000 population, respectively. No cases were reported during 2021–2022, but significant increases occurred in 2023–2024, with occurrence rates reaching 24.96%. Infants under 1 year and children aged 1–4 years showed the highest risk regardless of gender. Forty-five sub-districts were identified as high-risk areas, predominantly concentrated in Pattani (25 sub-districts) and Yala (13 sub-districts). Conclusions Young children aged less than 1 and 1–4 years constitute the highest-risk group for pertussis in Thailand’s southernmost provinces. The concentration of cases in rural, densely populated areas of Pattani and Yala with Aiyoewaeng as the hotspot area highlights the urgent need for targeted vaccination strategies and improved vaccine coverage, particularly focusing on maternal vaccination and addressing religious and cultural barriers to immunization.

Electronic health record (EHR) data are widely used in public health research, including in HIV-related studies, but are limited by potential bias due to incomplete and inaccurate information, lack of generalizability, and lack of representativeness. This study explores how workflow processes among HIV health care providers (HCPs), data scientists, and state health department professionals may potentially introduce or minimize bias within EHR data. One focus group with 3 health department professionals working in HIV surveillance and 16 in-depth interviews (ie, 5 people with HIV, 5 HCPs, 5 data scientists, and 1 health department professional providing retention-in-care services) were conducted with participants purposively sampled in South Carolina from August 2023 to April 2024. All interviews were transcribed verbatim and analyzed using a constructivist grounded theory approach, where transcripts were first coded and then focused, axial, and theoretically coded. The EHR data lifecycle originates with people with HIV and HCPs in the clinical setting. Data scientists then curate EHR data and health department professionals manage and use the data for surveillance and policy decision-making. Throughout this lifecycle, the three primary stakeholders (ie, HCPs, data scientists, and health department professionals) identified challenges with EHR processes and provided their recommendations and accommodations in addressing the related challenges. HCPs reported the influence of socio-structural biases on their inquiry, interpretation, and documentation of social determinants of health (SDOH) information of people living with HIV, the influence of which is proposed to be mitigated through people living with HIV access to their EHRs. Data scientists identified limited data availability and representativeness as biasing the data they manage. Health department professionals face challenges with delayed and incomplete data, which may be addressed statistically but require consideration of the data's limitations. Overall, bias within the EHR data lifecycle persists because workflows are not intentionally structured to minimize bias and there is a diffusion of responsibility for data quality between the various stakeholders. From the perspective of various stakeholders, this study describes the EHR data lifecycle and its associated challenges as well as stakeholders' accommodations and recommendations for mitigating and eliminating bias in EHR data. Based upon these findings, studies reliant on EHR data should adequately consider its challenges and limitations. Throughout the EHR data lifecycle, bias could be reduced through an inclusive, supportive health care environment, people living with HIV verification of SDOH information, the customization of data collection systems, and EHR data inspection for completeness, accuracy, and timeliness. Future research is needed to further identify instances where bias is introduced and how it can best be mitigated and eliminated across the EHR data lifecycle. Systematic changes are necessary to reduce instances of bias between data workflows and stakeholders.

Despite its effectiveness in HIV prevention, PrEP use among Black women is suboptimal. Notably in the Deep South, Black women have the lowest PrEP uptake rates among all US regions. To increase PrEP engagement, research suggests the implementation of structural and social interventions particular to the needs of Black women. The state of Alabama is of priority to federal HIV prevention initiatives; therefore, this study conducted focus groups among 47 cis-gender Black women in rural and urban Alabama counties, with the highest statewide HIV incidence rates, to understand perceptions of PrEP and decision-making processes. Deductive coding analysis was conducted and themes were finalized based on consensus among the two coders. Four themes were identified. Findings show stigma undergirds Alabaman Black women’s decisions to engage in PrEP care. Moreover, women reported stigma stifled community-level education about PrEP. Despite these experiences, education was regarded as a strategy to decrease stigma and PrEP skepticism, the latter of which emerged as a prominent theme. Medical mistrust and healthcare engagement were the other emergent themes influencing participation in PrEP care. To ensure PrEP efforts meet the needs of Black cisgender women in Alabama counties, interventions must address longstanding stigma, increase educational initiatives, and ensure interventions consider women’s experiences with medical mistrust and health care engagement.

Background: Rates of severe maternal mor­bidity and maternal mortality (SMM/MM) in the United States are rising. Disparities in SMM/MM persist by race, ethnicity and geography, and could partially be attributed to social determinants of health.Purpose: Utilizing data from the largest, statewide referral hospital in Alabama, we investigated the relationship between residence in disadvantaged neighborhoods and SMM/MM.Methods: Data on all pregnancies between 2010 and 2020 were included; SMM/MM cases were identified using CDC definitions. Area deprivation index (ADI) available at the census-block group was geographically linked to individual records and categorized using quintile cutoffs; higher ADI score indi­cated higher socioeconomic disadvantage. Generalized estimating equation models were used to adjust for spatial autocorrela­tion and ORs were computed to evaluate the relationship between ADI and SMM/ MM, adjusted for covariates including age, race, insurance, residence in medically underserved areas/population (MUAP), and urban/rural residence.Results: Overall, 32,909 live-birth deliveries were identified, with a prevalence of 9.8% deliveries with SMM/MM with blood trans­fusion and 5.3% without blood transfusion, respectively. Increased levels of ADI were associated with increased odds of SMM/ MM. Compared to women in the lowest quintile, the adjusted OR for SMM/MM among women in highest quintile was 1.78 (95%CI, 1.22-2.59, P=.0027); increas­ing age, non-Hispanic Black, government insurance and residence in MUAP were also significantly associated with increased odds of SMM/MM.Conclusion: Our results suggest that resi­dence within disadvantaged neighborhoods may contribute to SMM/MM even after adjusting for patient-level factors. Measures such as ADI can help identify the most vulnerable populations and provide points to intervene.Ethn Dis.2022;32(4):293-304; doi:10.18865/ed.32.4.293

Background: Cardiovascular disease remains a leading cause of preventable mortality in the United States, with rural counties in the Deep South experiencing disproportionately high burdens. Grounded in the Andersen healthcare utilization model, this study examined how enabling resources, predisposing characteristics, and access-related barriers relate to coronary heart disease (CHD) prevalence and mortality. Methods: This ecological analysis included 418 counties across Alabama, Georgia, Louisiana, Mississippi, and South Carolina. Using Local Indicators of Spatial Association (LISA) and multivariable linear regression, we tested three theory-based hypotheses and assessed the spatial clustering of CHD outcomes, while identifying key structural and sociodemographic predictors. Results: Counties with greater rurality and fewer healthcare providers exhibited significantly higher rates of CHD prevalence and mortality. Primary care provider availability and higher household income were protective factors. Digital exclusion, measured by lack of access to computers or mobile devices, was significantly associated with higher CHD prevalence and mortality. Spatial analysis identified the counties with better-than-expected cardiovascular outcomes despite structural disadvantages, suggesting the potential role of localized resilience factors and unmeasured community-level interventions. Conclusions: The findings affirm the relevance of the Andersen model for understanding rural health disparities and highlight the importance of investing in both digital infrastructure and healthcare capacity. Expanding telehealth without addressing provider shortages and social determinants may be insufficient. Local policy innovations and community resilience mechanisms may offer scalable models for improving cardiovascular health in disadvantaged areas.

Background: The COVID-19 pandemic has posed unprecedented pressure to health care systems, and interrupted health care delivery and access including HIV care in the United States’ Deep South, which endures a double epidemic of HIV and COVID-19. Ryan White programs cover HIV care services for over half of PLWH in the Deep South. Given the important role of Ryan White programs, examining the visitation changes to Ryan White facilities during the pandemic offers insights into the impact of the pandemic on HIV healthcare utilization. Objectives: Analyze the geographic distribution of HIV facility visitors at the county level before and during the pandemic in the nine US states of Deep South (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas) to reveal the geographic and racial disparity in visitation disruption caused by the pandemic. Methods: We first extracted mobile device-based visitation data for Ryan White HIV facilities in the Deep South during 2019 and 2020. To quantify the disruption in visitations during 2020, we calculated the visitation reduction rate (VRR) for each county, using 2019 data as the baseline. Next, we conducted a spatial analysis of the VRR values to uncover geographical disparities in visitation interruptions. To investigate racial disparities, we performed spatial regression analyses with VRR as the dependent variable, and the percentages of Black, Hispanic, and Asian populations as the independent variables. In this analysis, we controlled for potential confounders. Results: Geographic disparities in visitation reduction were observed, with all nine Deep South states experiencing significant drops. Georgia experienced the highest visitation loss (VRR = -0.58), followed by Texas (-0.47), Alabama (0.47), and Tennessee (-0.46), while South Carolina had the smallest reductions (-0.11). All the regression models consistently revealed racial disparities in visitation interruption. That is, counties with a higher proportion of Black population tended to have higher RW facility visitation reductions. Conclusions: Our analysis revealed distinct geographic disparities in visitation interruptions at Ryan White HIV facilities in the Deep South during the COVID-19 pandemic in 2020. Furthermore, we found that the Black/African American population experienced a greater disruption at the county level in the Deep South during this period.

Although racial sexual exclusivity among Black gay, bisexual, and other sexual minority men (SMM) is frequently framed as a cause of HIV inequities, little research has examined how these sexual relationships may be driven by and protective against racism. This study examined associations between general racial discrimination, Black sexual exclusivity, sexual racial discrimination, and depressive symptoms among Black SMM. We conducted analyses on cross-sectional self-report data from 312 cisgender Black SMM in the U.S. Deep South who participated in the MARI study. Measures included general racial and sexual identity discrimination, race/ethnicity of sexual partners, sexual racial discrimination, and depressive symptoms. We estimated a moderated-mediation model with associations from discrimination to Black sexual exclusivity, moderated by discrimination target, from Black sexual exclusivity to sexual racial discrimination, and from sexual racial discrimination to depressive symptoms. We tested an indirect effect from racial discrimination to depressive symptoms to examine whether Black sexual exclusivity functioned as an intervening variable in the associations between racial discrimination and depressive symptoms. Results indicated that participants who experienced racial discrimination were more likely to exclusively have sex with Black men. Men with higher Black sexual exclusivity were less likely to experience sexual racial discrimination and, in turn, reported lower depressive symptoms. The indirect pathway from racial discrimination to depressive symptoms through Black sexual exclusivity and sexual racial discrimination was significant. Our results suggest that one of the drivers of sexual exclusivity among Black SMM may be that it helps to protect against the caustic psychological effects of racial discrimination.