Medical mistrust grounded in structural and systemic racism affects HIV care for Black women in the US South

Medical mistrust grounded in structural and systemic racism affects HIV care for Black women in the US South


Credit: CC0 Public Domain

For Black women in the southern United States, mistrust of the health care system that is grounded in structural and systemic racism is a key factor affecting participation in HIV prevention and treatment services, reports a study in the September/October issue of The Journal of the Association of Nurses in AIDS Care (JANAC).

“[Our] results indicate that there are barriers to the utilization of health services that are grounded in personal experiences, historical mistrust for the health care system and systemic racism,” according to the qualitative study by Schenita D. Randolph, Ph.D., MPH, of Duke University School of Nursing and colleagues. “HIV programs serving Black women should include conversations around structural racism and trust for both providers and patients.”

“Dr. Randolph’s findings are critical because they demonstrate women’s own views of the critical and sometimes subtle ways in which systemic racism can have dramatic effects on African-American women’s health through multiple pathways,” said Dr. Carol Golin, Professor of Medicine and Public Health at the University of North Carolina at Chapel Hill. “This suggests that working to dismantle racism is a fundamental step that is needed to fully address health disparities.” Dr. Golin was Principal Investigator of the community-based parent study in which the data were collected.

New Insights on Obstacles to Black Women’s Participation in HIV Care

Disparities in HIV risk are an important public health issue for Black women, particularly in the South. “Black women have nearly 20 times the risk of white women in being infected with HIV, and lifetime HIV risk is greatest for people living in the southern United States,” according to the authors.

In a previous study, authors identified Black women’s perceptions of structural racism and discrimination, and medical mistrust, as critical factors in the development of HIV prevention programs and interventions. The new study further explored those perspectives through a series of focus groups with African-American women living in low-income housing communities in one small city in the South.

Although they did not use those exact terms, the participants consistently communicated that the concepts of structural racism and discrimination, and medical mistrust, had a significant impact on their health care decisions and participation. From the focus group discussions, four subthemes emerged:

  • Decreased trust in health care advice and instructions. Based on their experiences, some of the women perceived that health care professionals give incomplete or even false medical information to Black patients. They also viewed some medical facilities as being more trustworthy or more receptive to Black patients than others.
  • Systems and structures placing Black women at a disadvantage. “Institutional and systematic regulations”—especially policies related to living in low-income housing—contributed to mistrust of the health care system. Participants perceived that that the combination of being Black and being a woman added “a layer of challenges” to accessing health care. The women felt there were “little to no resources in the community to access affordable health care.”
  • Lack of effective communication. The women reported experiences with lack of communication in the health care system, including misinformation and not receiving details of the care being given. Some women did report effective communication with providers—showing that taking time to build good communication and relationships can lead to improved health behaviors.
  • Need for empowerment in clinical encounters. Perceived racial bias in dealings with health care providers motivated the women to be more assertive in advocating for their rights. They felt they should be able to question health care recommendations and demand more information from providers.

“These findings support the importance for health care providers, as well as researchers, to be aware of systematic racism and structural discrimination that may be overt or covert in our health care systems,” Dr. Randolph and coauthors write. They note that the focus group participants voiced a strong preference for HIV-related messaging and programming to be delivered by “trusted individuals or gatekeepers” in the community, whom they viewed are more relatable than health care providers. The findings also highlight the need for “careful attention to interpersonal relationships and communication in the clinical encounter with Black women.”

“Findings on the understanding of Black women’s skepticism of medical providers and systems reinforced and expanded our view of the importance of addressing these trust issues in future HIV prevention efforts with this population,” the researchers write. “More importantly,” Dr. Randolph comments, “findings expanded our view of the importance of addressing how our systems that are grounded in historical racism, contribute intentionally or unintentionally to the inequities of care among Black women.”

Dr. Randolph and coauthors conclude: “This long history will require that critical conversations about structural and systemic racism and health take place to begin breaking deeply ingrained cycles of discrimination.”


Racial discrimination may adversely impact cognition in African Americans


More information:
Randolph, Schenita D. et al. How Perceived Structural Racism and Discrimination and Medical Mistrust in the Health System Influences Participation in HIV Health Services for Black Women Living in the United States South: A Qualitative, Descriptive Study. Journal of the Association of Nurses in AIDS Care. September-October 2020 – Volume 31 – Issue 5 – p 598-605 DOI: 10.1097/JNC.0000000000000189

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Citation:
Medical mistrust grounded in structural and systemic racism affects HIV care for Black women in the US South (2020, September 17)
retrieved 17 September 2020
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What causes such big differences in cities' tolls?

What causes such big differences in cities’ tolls?


COVID-19 data as of May 31, 2020. Credit: The Conversation, CC-BY-ND Source: U.S. Census, NOAA, City of New York, City of San Francisco

San Francisco and New York City both reported their first COVID-19 cases during the first week of March. On March 16, San Francisco announced it was ordering residents to stay home to avoid spreading the coronavirus, and New York did the same less than a week later. But by the end of May, while San Francisco had attributed 43 deaths to COVID-19, New York City’s death count was over 20,000.

What explains the stark difference in COVID-19-related deaths between these two cities? Is the delay in the stay-at-home order responsible? What about city-specific measures taken to mitigate COVID-19 before the order? Is something else going on?

The divergent trajectories of San Francisco and New York City, while especially striking, are not unique. Worldwide, COVID-19 is having highly variable effects. Within the U.S., infections, hospitalizations and deaths have skyrocketed in nearly all major cities in the Northeast while remaining fairly low in some other metropolitan centers, such as Houston, Phoenix and San Diego.

How cities and states implemented public health interventions, such as school closures and stay-at-home orders, has varied widely. Comparing these interventions, whether they worked and for whom, can provide insights about the disease and help improve future policy decisions. But accurate comparisons aren’t simple.

The range of COVID-19 interventions implemented across the U.S. and worldwide was not random, making them difficult to compare. Among other things, population density, household sizes, public transportation use and hospital capacity may have contributed to the differences in COVID-19 deaths in San Francisco and New York City. These sorts of differences complicate analyses of the effectiveness of responses to the COVID-19 pandemic.

As a biostatistician and an epidemiologist, we use statistical methods to sort out causes and effects by controlling for the differences between communities. With COVID-19, we’ve often seen comparisons that don’t adjust for these differences. The following experiment shows why that can be a problem.

Coronavirus deaths in San Francisco vs. New York: What causes such big differences in cities' tolls?
Credit: Laura Balzer/Github, CC BY-ND

City simulations reveal a paradox

To illustrate the dangers of comparisons that fail to adjust for differences, we set up a simple computer simulation with only three hypothetical variables: city size, timing of stay-at-home orders and cumulative COVID-19 deaths by May 15.

For 300 simulated cities, we plotted COVID-19 deaths by the delay time, defined as the number of days between March 1 and the order being issued. Among cities of comparable size, delays in implementing stay-at-home orders are associated with more COVID-19 deaths—specifically, 40-63 more deaths are expected for each 10-day delay. The hypothetical policy recommendation from this analysis would be for immediate implementation of stay-at-home orders.

Now consider a plot of the same 300 simulated cities that doesn’t take city size into consideration. The relationship between delays and deaths is reversed: Earlier implementation in this simulation is strongly associated with more deaths, and later implementation with fewer deaths. This apparent paradox occurs because of the causal relationships between city size, delays and COVID-19 deaths. Strong connections or associations between two variables don’t guarantee that one variable causes another. Correlation does not imply causation.

Failing to properly address these relationships can create misperceptions with dramatic implications for policymakers. In these simulations, the analysis that fails to consider city size would lead to an erroneous policy recommendation to delay or never implement stay-at-home orders.

Coronavirus deaths in San Francisco vs. New York: What causes such big differences in cities' tolls?
Credit: Laura Balzer/Github, CC BY-ND

It gets more complicated

Of course, causal inference in real life is more complicated than in a computer simulation with only three variables.

In addition to confounding factors like community size, substantial evidence suggests that public health interventions do not protect all people equally.

In San Francisco, stark disparities have emerged. For example, comprehensive testing of the Mission District revealed 95% of people testing positive were Hispanic. Factors like socioeconomic status, race and ethnicity, and many others, vary widely among communities and can impact COVID-19 infection and death rates. Differences among community residents makes appropriate interpretation of comparisons, such as between San Francisco and New York, even more difficult.

So how do we effectively learn in the current environment?

While especially pressing now, the analytic challenges posed by COVID-19 are not new. Public health experts have long used data from nonrandomized studies—even in the midst of epidemics. During the Cholera outbreak in London in 1849, John Snow, famed in epidemiologic circles, used available data, simple tools and careful consideration to identify a water pump as a source of disease spread. Evidence-based decisions require both data and appropriate methods to analyze data.

Cities and communities worldwide vary in important ways that can complicate public health research. The rigorous application of causal inference methods that can take into account differences between populations is necessary to guide policy and to avoid misinformed conclusions.


Follow the latest news on the coronavirus (COVID-19) outbreak


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Coronavirus deaths in San Francisco vs. New York: What causes such big differences in cities’ tolls? (2020, June 2)
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How our brains can be manipulated to tribalism

How our brains can be manipulated to tribalism


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Tribalism has become a signature of America within and without since the election of President Trump. The nation has parted ways with international allies, left the rest of the world in their effort to fight the climate change, and most recently the pandemic, by leaving the World Health Organization. Even the pandemic was not a serious issue of importance to our leaders. We did not care much about what was happening in the rest of the world, as opposed to the time of previous pandemics when we were on the ground in those countries helping block the progress so long as it was China’s or the European Union’s problem. This marks drastic change from previous U.S. altruistic attitude, including during the World War II.

Whether Trump is the cause or effect of the changes in America’s collective attitude, an attribute of our current president is his eagerness and ability to use fear for intimidation of those who disagree with him, and subordination and shepherding of those who support him.

Fear is arguably as old as life. It is deeply ingrained in the living organisms that have survived extinction through billions of years of evolution. Its roots are deep in our core psychological and biological being, and it is one of our most intimate feelings. Danger and war are as old as human history, and so are politics and religion.

I am a psychiatrist and neuroscientist specializing in fear and trauma, and I have some thoughts on how politics, fear and tribalism are intertwined in the current events.

We learn fear from tribe mates

Like other animals, humans can learn fear from experience, such as being attacked by a predator, or witnessing a predator attacking another human. Furthermore, we learn fear by instructions, such as being told there is a predator nearby.

Learning from our tribe mates is an evolutionary advantage that has prevented us from repeating dangerous experiences of other humans. We have a tendency to trust our tribe mates and authorities, especially when it comes to danger. It is adaptive: Parents and wise old men told us not to eat a special plant, or not to go to an area in the woods, or we would be hurt. By trusting them, we would not die like a great-grandfather who died eating that plant. This way, we accumulated knowledge.

Tribalism has been an inherent part of human history, and is closely linked with fear. There has always been competition between groups of humans in different ways and with different faces, from brutal wartime nationalism to a strong loyalty to a football team. Evidence from cultural neuroscience shows that our brains even respond differently at an unconscious level simply to the view of faces from other races or cultures.

At a tribal level, people are more emotional and consequently less logical: Fans of both teams pray for their team to win, hoping God will take sides in a game. On the other hand, we regress to tribalism when afraid. This is an evolutionary advantage that would lead to the group cohesion and help us fight the other tribes to survive.

Tribalism is the biological loophole that many politicians have banked on for a long time: tapping into our fears and tribal instincts. Abuse of fear has killed in many faces: extreme nationalism, Nazism, the Ku Klux Klan and religious tribalism have all led to heartless killing of millions.

The typical pattern is to give the other humans a different label than us, perceive them as less than us, who are going to harm us or our resources, and to turn the other group into a concept. It does not have to necessarily be race or nationality. It can be any real or imaginary difference: liberals, conservatives, Middle Easterners, white men, the right, the left, Muslims, Jews, Christians, Sikhs. The list goes on and on.

This attitude is a hallmark of the current president. You could be a Chinese, a Mexican, a Muslim, a Democrat, a liberal, a reporter or a woman. So long as you do not belong to his immediate or larger perceived tribe, he portrays you as subhuman, less worthy, and an enemy.

Retweeting “The only good Democrat is a dead Democrat” is a recent example of how he feeds, and feeds off of such divisive and dehumanizing tribalism.

When building tribal boundaries between “us” and “them,” politicians have managed very well to create virtual groups of people that do not communicate and hate without even knowing each other: This is the human animal in action!

Fear is uninformed, illogical and often dumb

Very often my patients with phobias start with: “I know it is stupid, but I am afraid of spiders.” Or it may be dogs or cats, or something else. And I always reply: “It is not stupid, it is illogical.” We humans have different functions in the brain, and fear oftentimes bypasses logic. In situations of danger, we ought to be fast: First run or kill, then think.

This human tendency is meat to the politicians who want to exploit fear: If you grew up only around people who look like you, only listened to one media outlet and heard from the old uncle that those who look or think differently hate you and are dangerous, the inherent fear and hatred toward those unseen people is an understandable (but flawed) result.

To win us, politicians, sometimes with the media’s help, do their best to keep us separated, to keep the real or imaginary “others” just a “concept.” Because if we spend time with others, talk to them and eat with them, we will learn that they are like us: humans with all the strengths and weaknesses that we possess. Some are strong, some are weak, some are funny, some are dumb, some are nice and some not too nice.

Fear can easily turn violent

There is a reason that the response to fear is called the “fight or flight” response. That response has helped us survive the predators and other tribes that have wanted to kill us. But again, it is another loophole in our biology to be abused. By scaring us, the demagogues turn on our aggression toward “the others,” whether in the form of vandalizing their temples, harassing them on the social media, of killing them in cold blood.

When demagogues manage to get hold of our fear circuitry, we often regress to illogical, tribal and aggressive human animals, becoming weapons ourselves—weapons that politicians use for their own agenda.

The irony of evolution is that while those attached to tribal ideologies of racism and nationalism perceive themselves as superior to others, in reality they are acting on a more primitive, less evolved and more animal level.


The politics of fear: How it manipulates us to tribalism


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Trump, the politics of fear and racism: How our brains can be manipulated to tribalism (2020, June 2)
retrieved 2 June 2020
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Notre Dame will rise from the ashes even greater than before – Lonely Planet's travel blog

Notre Dame will rise from the ashes even greater than before – Lonely Planet’s travel blog


Wonderings: rambles through and reflections on travel… this month, James Kay says that Notre Dame will emerge from the recent fire as an even greater monument © Joe Davis / Lonely Planet

Many years ago, I climbed the spiral staircase that winds its way up to the balcony connecting the two towers of the Cathédrale Notre Dame de Paris’ western facade. From there, you can see many of the city’s greatest landmarks: the Eiffel Tower, the Basilique du Sacré-Cœur, the Arc de Triomphe, the River Seine flowing past Île de la Cité.

A close inspection of the gargoyles and chimeras festooning the towers is just as engrossing as that far-reaching, wide-angle view. Jutting out from the walls, the gargoyles’ long necks channel water away from the ancient stone; the chimeras – horned, winged, taloned, feathered; beasts that never were – are there to ward off evil.

But none of them could protect the 12th-century building from the fury of a different element yesterday. Mercifully, the towers still stand, but the fire which began in the afternoon and raged through the night consumed the roof and toppled the spire.

Fire in the heart

I feel for the Parisians who lined the banks of the Seine to witness the conflagration, those vaulting flames mirrored in their tears. So do millions of other well-wishers around the world, for this is a building etched into the collective consciousness, a Unesco World Heritage site visited by millions of people a year.

Hyperbole aside, its destruction is a true tragedy. Notre Dame is the heart not just of Paris, but also of France, and not in a merely abstract sense: the brass plate set into the ground outside the western facade marks the city centre and the point from which the distance from Paris to all destinations is measured.

But, as we mourn, let’s remember that this heart will beat again.

Firefights battling the blaze yesterday as it spread across the roof of Cathédrale Notre Dame de Paris Firefights battling the blaze yesterday as it spread across the roof of Cathédrale Notre Dame de Paris © Pierre Suu / Getty Images

If you look north from our office in London, you can see across the River Thames to the towers of St Paul’s Cathedral’s west front. The cathedral – a place of comparable cultural clout to Notre Dame – is now in its fourth incarnation. Sir Christopher Wren’s masterpiece was built in the late 17th century after its predecessor was destroyed… by the Great Fire of London.

Contemporary accounts describe molten lead pouring from the roof of Old St Paul’s into the warren of streets below, causing the pavements to glow like flows of lava. So intense was the inferno that witnesses a furlong away – about 200 metres – could not face the flames.

Symbols of resilience

It took 35 years for the St Paul’s we know today to rise from the ashes – but rise it did, an irrepressible phoenix, just as it had from previous fires in 962, 1087 and 1561.

Furthermore, I’d argue that with each rebuild, just as the physical cathedral became a little bigger, so did its psychogeographical scale – that is, the amount of space it occupies in our minds. Along with all the other things for which it stands, St Paul’s became a potent symbol of the city’s resilience.

While I don’t speak for them, I’d wager that the residents of Utrecht, Barcelona and Cologne feel much the same way about St Martin’s, Santa Maria Del Mar and Cologne Cathedral respectively, all of which were ravaged by, and reborn from, fire at one time or another in their long histories.

It won’t take 35 years to restore Notre Dame, which has survived revolutions and wars, and hosted the crowning of kings and the coronation of emperors. French president Emmanuel Macron has already launched an international campaign and hundreds of millions of euros are pouring into the reconstruction fund.

And whenever this storied structure does reopen to the public, its hold on our imaginations will have grown, not diminished. So let’s look forward to the day when the bells of Our Lady ring out over the rooftops of Paris once more.



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More profound than previously reported

More profound than previously reported


Credit: CC0 Public Domain

The effects of exercise on metabolism are even greater than scientists believed. That’s the finding of a unique study published today in Cardiovascular Research, a journal of the European Society of Cardiology (ESC).

The study is the first to examine the metabolic effects of exercise while carefully controlling for differences between participants in diet, stress, sleep patterns, and work environment.

“These results show that metabolic adaptation to exercise is far more profound than previously reported,” said senior author Dr. John F. O’Sullivan of the University of Sydney, Australia. “The results increase our knowledge of the widespread benefits of exercise on metabolism and reveal for the first time the true magnitude of these effects. This reinforces the mandate for exercise as a critical part of programmes to prevent cardiovascular disease.”

One of the major challenges when studying the effects of exercise is controlling for factors that differ between participants and could influence the results. For example: age, gender, weight, baseline fitness, diet (some healthy, some very unhealthy), sleep patterns, jobs (physical work versus a desk job), alcohol, and smoking.

“Our motivation for this study was to overcome this limitation by studying exercise under controlled conditions, thereby revealing the true extent of effects on the body,” said Dr. O’Sullivan. “Therefore, we used a cohort of newly-enlisted healthy male soldiers of similar age and baseline fitness who lived in the same domicile, had the same sleep patterns, ate the same food, and underwent the same exercise regimen.”

One of the major benefits of exercise is on metabolism, which is how the body converts food into energy and eliminates waste. Substances produced during metabolism are called metabolites. “Metabolites are the intermediates of the metabolic machinery in the body and can signal how metabolic health is changing in response to exercise,” explained Dr. O’Sullivan.

The researchers measured approximately 200 metabolites in the blood of 52 soldiers before and after an 80-day aerobic and strength exercise programme and related these to changes in fitness.

Compared to previous studies, the researchers found dramatic changes in many metabolites. Trained, energy-efficient muscle used far more fuel—for example fat—than shown ever before. The researchers also captured heretofore unseen, in terms of scale and scope, changes in levels of factors derived from the gut, factors involved in blood clotting, breakdown products of protein, and factors involved in opening up blood vessels to increase blood flow.

Participants who did not experience these metabolic benefits of exercise had higher levels of a metabolite called DMGV. “This is intriguing because a recent study also found that this metabolite predicted who did not benefit from exercise,” said Dr. O’Sullivan. “DMGV levels are influenced by genetics and diet, rising with sugary drinks and falling with vegetables and fibre. Measuring DMGV may identify people who need strategies other than exercise to reduce their cardiovascular risk.”

He concluded: “The power of exercise to boost metabolism is on top of its positive effects on blood pressure, heart rate, fitness, body fat, and body weight. Our findings cement the central role of exercise in preventing cardiovascular disease.”


Exercise works for those beginning cancer treatment


More information:
Yen Chin Koay et al, Effect of chronic exercise in healthy young male adults: a metabolomic analysis, Cardiovascular Research (2020). DOI: 10.1093/cvr/cvaa051

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Benefits of exercise on metabolism: More profound than previously reported (2020, April 2)
retrieved 2 April 2020
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In the white alleys of Santorini

In the white alleys of Santorini

Our weekly Santorini private tour takes its next stop here, in a picture where the clouds paint with the colours of the sun and canvas on the sky. A magnificent sunset in the most romantic corner of our country, somewhere in the white alleys of Santorini.

Santorini, or Thira, is the most famous Greek island in the world. There are few who fall in love or live in love in this beautiful place. The moment of sunset on the island has its own daily, but always special atmospheric magic.

It is time for the caves of Oia to be filled with people from all parts of the earth. The ruins of the castle of Agios Nikolaos are their usual destination, and there the dream of the sun sinking into the atmosphere seems dreamy…

A natural spa in the shade of the volcano

It was not the first time we were lured into addictive tasting routes and endless strolls to the most romantic island of the Cyclades. But amidst the general mood of relaxation and tranquillity that accompanied our summer vacation in Santorini, we decided to embark on a little more adventure…

So we didn’t miss out on getting acquainted with the myth of the volcano and discovering its secret secrets. We followed an information about a hot springs beach, with mineral-rich waters and sulfur dioxide bubbles gushing from the bottom, so we decided, without hesitation, what our next destination would be!

Old Kameni

In Old Kameni, the landscape gives the impression of a wild, perhaps even hostile. A whitewashed church stands to guard the waters, dedicated to the patron of the seas, Saint Nicholas, and contrasts between black and blue. But before our boat turned, we heard people and saw the sea turn green and immediately yellow. We were surprised! If we did not know what was going on there, we might have second thoughts about whether we would dive into these strange waters.

We left our stuff in the boat and one after the other we took a deep breath and showed our diving performance. The first contact with water there felt different, with intense alternations of cold and hot streams flowing through the skin and leaving a – unexpectedly – soft feeling. As we swam to the shallows, the warmth of the water began to surround us, and the smell of the brimstone gradually became more intense in our nostrils.

The beach of Agios Nikolaos

Until we could reach the shore and be able to walk, no one could understand where everyone had found this yellowish hue on their skin. But with the first finger touching the bottom, it was immediately clear… The shallow waters of Agios Nikolaos beach are covered by a layer of pale mud, rich in sulphur, manganese, iron and other extraordinary minerals rheumatism, arthritis and other pains.

Santorini volcano hot springs

As we were distracted by the feeling of mud in our hands and feet, and laughing at the color our skin received from it, we assumed that the gentle caress on our feet was from some fish, which might have been accidental. We had not realized that the tickling touch came from the dance of hundreds of tiny bubbles that struggled to release themselves from the surface.

We stayed there for about 30 minutes and on our return, our sense of relaxation was over. We were sure that, for such care, we would have to pay enormously, but in Santorini, nature generously offers it with all the benefits of the elements.

The uninhabited islands of Nea and Old Kameni are certainly famous among those who love adventure, history and exploration, and even more famous among those who love bathing in hot springs. The Santorini are well aware of what the volcano has to offer, so they organize daily and regular itineraries for the two volcanic islands.

For an inexplicable reason, what scares or scares the rest, the Santorini does not scare them… They say that they have learned to live with the volcano and that an explosion always gives enough signs before it happens. Until then, all of us will continue to enjoy the island of Agia Irini as the most romantic and enchanting destination in Europe’s largest and most dreamy, volcanic caldera.

Where to see the sunset in Santorini

Santorini is a beautiful island in Greece, famous for its amazing sunset.

If you are someone who has not seen enough sunsets, then you should definitely visit Santorini for this reason alone: ​​to see the most beautiful sunset in the world.

Santorini sunset

Whether you are a romantic soul or not, if you ever find yourself in one of the streets of Santorini you will surely feel the beauty of the moment.

Santorini will show you her secret weapon! It will take you by the hand and lead you to Oia, just moments before sunset, and leave you there to admire the vast horizon that lies ahead of you with a fiery red sun somewhere in the depths of the Aegean! The sea loses its blue colour and becomes reddish, like the volcanic lava that created Santorini!

There are days when the streets of Oia are full of visitors from all over the world, flocking to see this unique spectacle of Santorini sunset. The ruins of Agios Nikolaos Castle, the churches and the rooftops are their usual destination, as they all look for a place that will help them enjoy the unique dreamy and atmospheric atmosphere.

The unique colour combinations as the sun sinks into the blue Aegean compose a romantic setting that touches every visitor.

Oia

Oia is located in the northern part of the island, 11 kilometres from Fira. It is famous for its sunset. Oia was one of the five castles of Santorini (the castle of Agios Nikolaos). The settlement reached its climax in the late 19th and early 20th centuries thanks to shipping, transit trade and agriculture.

Oia offers countless spots to enjoy sunset colours, much less crowded corners and 100% breathtaking views! Request Your Own Position!

Lighthouse in Akrotiri

Enjoy the famous sunset from the lighthouse in Akrotiri! The view is unique and you can see the whole island and Oia in the background as the sun dips into the sea! The world is much less than in Oia.

The lighthouse in Akrotiri is one of the most beautiful in the Cyclades. It was built in 1892 by the French Lighthouse Society. The height of the tower is 10 meters. Renovated in 1925, it ceased to function during World War II and became operational again in 1945. It was electrified in 1983 and its operation was automated in 1988.

If you want to experience the most complete and romantic tours in Santorini you have only to visit Santorini Tours website.

Read more about Santorini Tours:

best blogs, Instagram shots and videos from March 2019 – Lonely Planet's travel blog

best blogs, Instagram shots and videos from March 2019 – Lonely Planet’s travel blog


Where will our Pathfinders take you this month? © Alexander Ippolitov / Shutterstock

From New York’s stunning street art scene to Siberia’s wild winter wonderlands, our Pathfinders have been jet-setting across the globe and have returned with ever more inspiring tales of their adventures. Check out March’s round-up of our favourite blogs, Instagrams and videos.

Best of the blogs

Street art in New York city: a guide to the best hotspots – Carol Guttery

Taxis driving through Times Square, New York City Dive into the colour and chaos of New York City © Luciano Mortula – LGM / Shutterstock

Why we like it: Many cities now attract tourists with their thriving street art scenes, but it’s New York – back in the 1970s – where it all began. In this post Carol curates a tour of the Big Apple’s best street art spots, leading visitors to historic murals and lesser-known – but equally impressive – modern works. Striking imagery, an embedded map tool and an intro section detailing the interesting history of the art form (and its link with the city) enhance the post’s appeal further.

Carol’s blog aims to encourage travellers to go beyond the headline sights and find alternative and offbeat adventures. Learn more at wayfaringviews.com.

Landing in New Zealand – Javi Lorbada

Akaroa village on Banks Peninsula New Zealand Akaroa was made for road-tripping © KarlosXII / Shutterstock

Why we like it: Javi is a wizard when it comes to landscape photography, so a blog post about his first experiences of New Zealand was always likely to result in a mesmerising read. In this photoessay, Javi focuses on the Banks Peninsula, driving a rented campervan from Christchurch to Akaroa (stopping at a few scenic vantage points of course). With the pictures of the camper set against a star-strewn sky, we challenge anyone to read this and not be inspired to hit the open road themselves.

Born in Madrid, Javi travels far and wide in search of the perfect shot. Keep tabs on his latest work at javilorbada.com.

Top Instagram shots

Mexico City, Mexico – Axel Alvarado

Why we like it: In his brilliantly styled shot of one of Mexico City’s many Metro entrances, Axel uses the ornate, iron structure to frame blooming purple blossoms, creating the perfect central focus. The colour palette, which comprises muted pink hues and vivid violets set against the utility green of the foreground, works especially well when crowned by the dreamy blue sky, and the still-dimly-lit street lamps complete the overall effect with their warm, golden glow.

Axel is a keen travel photographer who loves nothing more than shooting the myriad charms of his home country, Mexico. Follow him on Instagram @axel.ach.

Siberia, Russia – Yan-Kei Clare

Why we like it: From the tangled network of ice cracks slicing through its lower half, to the central figures being dwarfed by the towering, craggy rock formation, this expert frame of Siberia’s Lake Baikal is full of drama. The glistening solid ice draws the eye towards the vivid white of the snow at the rock’s base, which appears all the more monolithic when acting as a backdrop for the image’s brightly clad (but miniscule) explorers. This is a cleverly crafted shot of nature at its most panoramic.

Yan-Kei is a globe-hopping travel blogger with restless feet and endless wanderlust. Follow her on Instagram @yan_keiclare.

Our favourite footage

Things to do in Tuscany – A Lovely Planet

Why we like it: Pacey, lively and compelling, this short film featuring Tuscany’s top attractions is a great showcase for the region’s many charms. Fusing sweeping, aerial views across rooftops and fields with up-close, on-the-ground footage of everything from church tower climbing to truffle foraging, this is a dynamic and fresh snapshot of one of Italy’s most popular regions.

Hayley and Enrico are a globetrotting travel team, exploring and capturing new experiences in every corner of the globe on camera, and through their blog A Lovely Planet.

Find out what else the Lonely Planet Pathfinders are up to by checking out the Pathfinders forum on Thorn Tree.





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have you felt a disturbance in the Force? – Lonely Planet's travel blog

have you felt a disturbance in the Force? – Lonely Planet’s travel blog


Wonderings: rambles through and reflections on travel… this month, James Kay travels to the parallel universe of the theme park © Joe Davis / Lonely Planet

It’s a special week for the 177,000-odd people in England and Wales, and many more around the world, who define their religion as Jedi: Saturday is Star Wars Day (May the Fourth, geddit?), the annual grassroots celebration of all things related to that galaxy far, far away.

Each year, fans of the franchise don robes, put lightsabers on charge and raise a glass of Bantha-blood fizz to the likes of Luke Skywalker, Princess Leia and Han Solo – or, if you bat for the Dark Side, Darth Vader and various lesser Darths. (Note to the Ewok-in-chief: no one, but no one, celebrates Jar Jar Binks, George.)

From uber-fans who livestream their reactions on YouTube as they watch trailers for forthcoming movies right down to closet-dwelling admirers of this rich fictional world like me, the creative juggernaut that first rolled into cinemas back in 1977 shows no sign of running out of road.

An expanding universe

Just like the real one, the Star Wars universe just keeps on expanding, an inflationary cultural phenomenon that has long outgrown its original medium, spawning countless spin-offs – books, games and enough merch to fill the hangar bay of a Star Destroyer (USD$32 billion of it, to be precise).

A few weeks ago, for example, I invested a chunk of cash in a Lego model of Luke’s X-Wing Starfighter (this age-inappropriate toy is now safely stowed in the eaves, but I’m confident that the kids will want to lead a Rebel raid on a half-built, papier mâché Death Star when the time is right – no, I defo didn’t buy it for myself).

And later this month, there will be a novel way to live this most protean of brands as never before: on the last day of May, Disneyland in California will lift the veil on the first phase of Star Wars: Galaxy’s Edge, a gazillion-dollar extension of the theme park that will, purportedly, transport guests to the remote planet of Batuu.

Once there, they can rub shoulders with shifty inter-galactic smugglers, pledge their undying allegiance to the Resistance or throw their lot in with the bad guys; they’ll even be able to take control of ‘the fastest hunk of junk in the galaxy’, aka the Millennium Falcon, thus fulfilling the ultimate fantasy of many a middle-aged geek.

have you felt a disturbance in the Force? – Lonely Planet's travel blog Visitors to Star Wars: Galaxy’s Edge can take the controls of the fastest ship in the galaxy, aka the storied Millennium Falcon © Disney Parks

That’s just for starters, too: a second, even shinier phase of this mega project will open later this year, as will a separate Star Wars-themed land at Walt Disney World in Florida. Price hikes notwithstanding, so popular are these attractions likely to be that Disney has made special arrangements to regulate the flow of visitors.

Putting any cynicism aside, there is much to admire about the ambition of all this. Given its storytelling skill and commercial nous, Disney is perhaps the perfect custodian of Star Wars; here was the ideal opportunity for its famed imagineers to dream the dreams of a billion fans and make them ‘real’ (note, pedants: there is no way to calculate the actual number of fans, but bearing in mind that the films alone have grossed nearly USD$10 billion, we can safely say there are… a lot).

Ever since Walt Disney opened his first resort in 1955, the company has pioneered a form of travel experience like no other. It’s not for everyone, of course – but from what I can see, it’s an experience in growing demand as theme parks proliferate around the world, perhaps supplanting other points of interest, whether natural or cultural, on our mental maps.

Escape and enlightenment?

The big boys – Disney itself, plus fellow industry titans like Merlin and Universal, and even lesser lights – are ceaselessly expanding their portfolios of parks, rides and hotels to cater for that demand, particularly in Asia where an emerging middle class’s thirst for entertainment is the engine of development.

Jediism never made it as an official religion. But one can make a case that theme parks are fast becoming to the 21st century what the great icons of religious architecture were to the 20th: places of pilgrimage where we seek escape and enlightenment. Okay, perhaps that’s not so true of Tyra Banks’ Modelland, but you catch my drift.

Meanwhile, in a strange twist, there is the curious case of Venice, a place that has become ever more theme park-like in its struggle to cope with a relentlessly rising tide of summer visitors. Attempts to install turnstiles on the Piazzale Roma might have foundered, but the mayor still plans to introduce a booking system for tourists in 2022, forcing visitors to reserve access to the city in much the same way as they might for, say, Star Wars: Galaxy’s Edge…



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exploring Panama – one of our top countries to visit in 2019 – Lonely Planet's travel blog

exploring Panama – one of our top countries to visit in 2019 – Lonely Planet’s travel blog


Sunset in the breathtaking El Valle ©Timothy Cohen

Lonely Planet Pathfinder, Timothy Cohen, is recently back from a whirlwind trip around Panama – one of our top countries to visit in 2019. From deserted beaches to bustling, urban hubs, here’s what he discovered…

Panama has always been a mystery to me. All I knew about the country was its world-famous canal. The closer I got to its border, the more fellow travellers I met who seemed dubious about my plan to explore the country for a whole month. It seemed that Panama is ‘travelled through’ rather than travelled itself. People do often transit there on their way to Colombia or Costa Rica, leaving behind them a country full of underrated gems. There are several ways to get into Panama from Colombia, but since entering by land is impossible due to the Darién Gap, I was left with three options – taking a flight, a five day boat trip from Cartagena, or a three day speedboat trip from Capurganá. I chose the latter – less popular and a little more adventurous…

The San Blas Archipelago

My boat trip took me through the archipelago of San Blas, inhabited by the Kuna people, an autonomous, indigenous group living on 49 of the 365 islands. I opted to use the services of a Kuna-based company, San Blas Frontera, to be sure that my money would end up staying within the community.

During the journey through the archipelago, we stopped off at a few islands. Some were inhabited, some had a small number of houses dotted around, and others were completely deserted. As well as meeting the Kuna communities, I was also lucky enough to enjoy the beautiful, sandy beach with not a care in the world (other than getting sunburn). A different sunny island for each day of the year – definitely something I could get used to!

Meeting the Kuna people

On the second day of the boat trip through San Blas, we dropped anchor on the island of Naranjo Chico. This small piece of land is home to a Kuna village and a handful of ‘cabañas’, in which my new travel companions and I spent the night. In Naranjo Chico, I met Johnny, a young Kuna local living on the island. He immediately befriended me, and was pretty intrigued by my camera!

Fun fact: until the late 1990s, the coconut was the principal currency in this region. Nowadays, although the Kuna people do still use the coconut as a currency, it has been overtaken by the US Dollar and the Balboa. Currently, one coconut is valued at only $0.40, but the Kuna people still find it amusing to say that, in this region at least, money really does grow on trees!

The Miami of Latin America

After three unforgettable days in San Blas, I set off to reach the mainland, and arguably the most cosmopolitan city in Central America. Panama City is the country’s capital, and a truly modern urban centre. Skyscrapers and huge malls are a common sight alongside the dazzling blue coastline. No wonder they call it the ‘Miami of Latin America’. Many worlds coexist here – west and east meet in a explosive cultural mix.

The business neighbourhood’s skyline, with its shimmering towers made of glass and steel, reflecting the azure of both the ocean and sky, could easily be mistaken for any north American megalopolis. As seen from the historical neighbourhood of Casco Viejo, with its crumbling convents, colonial architecture and cobble-stoned streets, the contrast with this skyline couldn’t be more pronounced.

Panama’s adventure town

In a country like Panama, which is synonymous with beaches, surfing and sun, the city of Boquete will delight the adventurers and lovers of balmy temperatures. Although it is only located 1200m above sea level, it lies at the foot of Baru, Panama’s tallest mountain standing at 3475m, which happens to also be an active stratovolcano. A popular hiking route finishes with watching the sunrise from the top. I had other plans however…

The surrounding area is teeming with trails and waterfalls hidden within the lush jungle, waiting to be explored. One of them, known as ‘The Lost Waterfalls’, is a three-hour journey through a cloud forest, leading to three beautiful waterfalls. During the dry season, the waterfalls surrounding Boquete are not as powerful as they are during the rainy season, but the weather is much nicer and the light is jaw-dropping!

The favourite

Bocas del Toro is one of Panama’s most popular destinations – easily accessible and teeming with things to do, the archipelago will keep you busy for days and days! Snorkelling, diving, partying, hiking, surfing, or just lazing around on a beach, you name it! Panama’s best parties can be found on the busy Isla Colon, while nature lovers may prefer to stay on Isla Bastimentos,where the eponymous national park can be found. I, of course, decided to stay on the latter.

The languorous Caribbean vibe emanating from the small town of Old Bank on Bastimentos’ shore is tangible. There are no roads, just a wide, concrete footpath lined on both sides with colourful wooden houses and plants. This particular footpath will lead you to the highest hill on the island, where the 360-degree view of the surrounding islands is outstanding. The icing on the cake is undoubtedly the organic cocoa farm nearby, perfect for taking a break while enjoying the natural surrounds.

Chasing sunlight

El Valle de Anton, more commonly known as ‘El Valle’, is a mountain town nestled in the crater of an extinct volcano. During my time here, I was truly chasing sunlight, sunsets in particular! On my first day, I decided to climb the mountain ‘Cara Iguana’ two hours before dusk, even though the peak was lost in the clouds. I’ve learned many times that weather changes extremely fast in the mountains, so I gave it a shot. Just as I was reaching the peak, it started to rain, and I couldn’t see anything at all, but then the wind slowed and suddenly the landscape appeared before my eyes, a big ray of sunlight breaking through the dark clouds and illuminating the hillside. I was in awe.

Even after so many years travelling, I am still constantly amazed by the world surrounding us. Gustave Flaubert once said that ‘travel makes one modest – you see what a tiny place you occupy in the world’, and I can’t help but think how right he was!

Do you love to write about your travels? Or perhaps Instagram is your thing? Find out more about how you can contribute to Lonely Planet here.





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what-is-femdom

What is Femdom?

We are looking at one more BDSM sex term and clearing up some false impressions and also bringing to light fascinating details … Femdom.. This term just implies Female or Womanly Domination/Dominatrix Athens call girl.

WHAT DOES FEMDOM CONSIST OF?

Dominance (whether male or female) is an EXTREMELY broad suggestion. Asking somebody what kind of domination they such as is the same as asking what somebody’s favourite food is. The solution can be anything, and as long as it follows the SSC policies, there is no right or incorrect.

Here lays one trouble …

Individual A might intend to dominate a person (allow’s claim with discomfort as well as embarrassment), however Individual B intends to be controlled, however not through harsh or degrading techniques. Finding the “ideal fit” between a Dom/sub or Top/bottom is a similar journey as common dating– it requires time, taking a look around, and also great deals of interaction (as well as experiencing a line of possible matches up until you get the ideal one).

So, Person B wishes to be dominated, but they desire it with gentle/kind means

This is where gentle Femdom comes in.

WHAT IS MILD FEMDOM?

It may sound like a contradiction, yet it’s not. It’s extremely feasible to dominate through non-harsh approaches. Think of a mom– they lead their children with love as well as generosity however additionally with a “firm” hand. Benefits are generous as well as punishments are often soft improvement (if penalties are even part of play, which, if the submissive doesn’t desire, you can leave out).

” No, sweetie, you can’t do that. It’s bad for you.”

” Give that back now, young man.”

CONFLICTS IN THE COMMUNITY

You’ll locate individuals, in any type of BDSM technique, you hold so true to their very own means, that they leave no room for various other ways by other individuals– even if those means have no bearing on other people. Significance, I have literally satisfied individuals who’ve claimed, “Gentle? Well, you’re not truly a Dom after that.” Or “That’s not truly BDSM.”

You find these people almost everywhere, also in non-BDSM things. “Oh, you consume red wine (of this brand) from 2014? Well, you know nothing concerning red wine after that.”

However guess what?

It does not frigging issue.

People are enabled to like their own food, very own brand name of a glass of wine, and own design of twist. If you are interested in mild dominance, do not let anyone inform you it’s “wrong”. I’m additionally mosting likely to most likely set off some readers as well as flat out claim that those kind of people are either snobs or uneducated regarding the twist world. Similar to they deserve to play how they want, you can play just how YOU as well as your companion want. Duration.

METHODS TO DOM CAREFULLY

Okay, since I’m done my tirade, allow’s check out a few straightforward suggestions you can attempt if you wish to enter gentle Femdom (bearing in mind that the Fem is for the female being the dominator– although you can completely have the same approach with a guy remaining in control).

  • Giving hugs, kisses, and also snuggles as rewards
  • Gently giving instructions as your partner satisfaction you
  • Giving your companion enjoyment, however you are in control of the rate and also result
  • Giving them a cute pet name
  • Allow them to be open as well as prone without humiliation
  • Be the one to hold them during the evening
  • Great deals of appreciation for good habits
  • Offering basic directions (exactly how to take off their garments and so on).
  • Making use of a vibrator on the surface for pleasure (rather than securing).
  • If he wants rectal sex, do it carefully and gradually.

Overall, this kind of supremacy is great for novices who intend to attempt to take control (or be controlled) yet aren’t certain regarding what style they want or like. From these simple actions, you can boost, even reduce, or alter the play to fit your and also your companion’s flavour.

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