Inherent complexities of a multi-stakeholder approach to building community resilience

Enhancing community resilience has increasingly involved national and regional governments adopting a multi-stakeholder approach because of the potential interagency benefits. This has led to questions about how best to involve stakeholder groups in translating community resilience policies into practice. This exploratory study contributes to this discussion by addressing two key areas that are fundamental in the concerted effort to build community resilience to natural hazards: (1) stakeholder understanding of community resilience as a concept; and (2) the difficulties associated with the processes of risk assessment and preparedness that stakeholders face locally in building community resilience. Data were collected through semistructured interviews with 25 practitioners and experts within Scotland’s resilience community, and were analyzed through an inductive approach to thematic analysis. These data show how the interpretation of community resilience differs across stakeholder groups. Analysis of the data reveals challenges around the nature of the risk assessment and its role in shaping risk perception and communication. Significant complications occur in communicating about low probability-high consequence events, perceived territoriality, competing risk prioritizations, and the challenges of managing hazards within a context of limited resources. The implications of these issues for policy and practice are also discussed

The Emerging HIV Epidemic on the Mexico-U.S. Border: An International Case Study Characterizing the Role of Epidemiology in Surveillance and Response

Purpose Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome surveillance data are critical for monitoring epidemic trends, but they can mask dynamic subepidemics, especially in vulnerable populations that underuse HIV testing. In this case study, we describe community-based epidemiologic data among injection drug users (IDUs) and female sex workers (FSWs) in two northern Mexico-U.S. border states that identified an emerging HIV epidemic and generated a policy response. Methods We draw from quantitative and qualitative cross-sectional and prospective epidemiologic studies and behavioral intervention studies among IDUs and FSWs in Tijuana, Baja California, and Ciudad Juarez, Chihuahua. Results The recognition that the HIV epidemic on Mexico’s northern border was already well established in subgroups in whom it had been presumed to be insignificant was met with calls for action and enhanced prevention efforts from researchers, nongovernmental organizations, and policy makers. Conclusions Successful policies and program outcomes included expansion of needle-exchange programs, a nationwide mobile HIV prevention program targeting marginalized populations, a successful funding bid from the Global Fund for HIV, TB, and Malaria to scale up targeted HIV-prevention programs, and the establishment of bi-national training programs on prevention of HIV and substance use. We discuss how epidemiologic data informed HIV prevention policies and suggest how other countries may learn from Mexico’s experience

A Subnational Examination of HIV/AIDS Mortality Rates in Mexico as a Function of the Social Gap Index and Multidimensional Poverty

Background: While Mexico has maintained a relatively low prevalence of HIV/AIDS and provides universal coverage of highly active antiretroviral therapy (HAART), HIV/AIDS mortality rates have failed to decrease at the national level. However, national trends mask heterogeneity in HIV/AIDS incidence and mortality across states and regions, a finding which likely parallels the distribution of social and economic inequality in Mexico. Objectives: As HIV/AIDS mortality likely differs as a function of community social and material deprivation, I evaluated the states’ annual HIV/AIDS mortality rates in Mexican residents aged 15 and over as a function of the Social Gap Index (SGIx) for each year from 2004-2011. Additionally, I evaluated the relationship between indicators of a state’s educational attainment, healthcare deprivation, and prevalence of poverty with annual mortality rates for each year from 2004-2011. Methods: Using demographic information and mortality data from the Mexican Ministry of Health’s Epidemiological and Statistical Mortality System and population level measures of social and material deprivation from The National Council for Evaluation of Social Development and Policy, univariate regression analysis and Pearson correlation were conducted to examine the relationship between annual mortality rate with state level indicators of educational gap, healthcare access, and poverty. Additionally ANOVA was conducted to examine the relationship with between annual mortality rate and state SGIx. All analyses were conducted for each year from 2004-2011. Results: Mean annual mortality rate at the national level steadily increased from 2005 (M=3.11, SD=1.67) to 2011 (M=3.97, SD=2.32), with the greatest mortality rate in the state of Tabasco (10.45 per 100,000) in 2010. Regression analysis and Pearson correlation indicated no statistically significant relationship between annual mortality and the component variables at the state level. Similarly, the relationship between state SGIx score and annual mortality rate was not statistically significant. Conclusions: This study demonstrates the limited predictive validity of state and population level measures in determining HIV/AIDS mortality rates. This is likely due to the concentration of HIV/AIDS among high-risk subpopulations in Mexico. Coupled with the limited effectiveness of universal HAART therapy, this suggests the need for future research which specifically samples from high-risk population groups, including men who have sex with men and female commercial sex workers

The Emerging HIV Epidemic on the Mexico-U.S. Border: An International Case Study Characterizing the Role of Epidemiology in Surveillance and Response

Purpose Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome surveillance data are critical for monitoring epidemic trends, but they can mask dynamic subepidemics, especially in vulnerable populations that underuse HIV testing. In this case study, we describe community-based epidemiologic data among injection drug users (IDUs) and female sex workers (FSWs) in two northern Mexico-U.S. border states that identified an emerging HIV epidemic and generated a policy response. Methods We draw from quantitative and qualitative cross-sectional and prospective epidemiologic studies and behavioral intervention studies among IDUs and FSWs in Tijuana, Baja California, and Ciudad Juarez, Chihuahua. Results The recognition that the HIV epidemic on Mexico’s northern border was already well established in subgroups in whom it had been presumed to be insignificant was met with calls for action and enhanced prevention efforts from researchers, nongovernmental organizations, and policy makers. Conclusions Successful policies and program outcomes included expansion of needle-exchange programs, a nationwide mobile HIV prevention program targeting marginalized populations, a successful funding bid from the Global Fund for HIV, TB, and Malaria to scale up targeted HIV-prevention programs, and the establishment of bi-national training programs on prevention of HIV and substance use. We discuss how epidemiologic data informed HIV prevention policies and suggest how other countries may learn from Mexico’s experience

Evaluating the impact of Mexico’s drug policy reforms on people who inject drugs in Tijuana, B.C., Mexico, and San Diego, CA, United States: a binational mixed methods research agenda

Background: Policymakers and researchers seek answers to how liberalized drug policies affect people who inject drugs (PWID). In response to concerns about the failing “war on drugs,” Mexico recently implemented drug policy reforms that partially decriminalized possession of small amounts of drugs for personal use while promoting drug treatment. Recognizing important epidemiologic, policy, and socioeconomic differences between the United States—where possession of any psychoactive drugs without a prescription remains illegal—and Mexico—where possession of small quantities for personal use was partially decriminalized, we sought to assess changes over time in knowledge, attitudes, behaviors, and infectious disease profiles among PWID in the adjacent border cities of San Diego, CA, USA, and Tijuana, Baja California, Mexico. Methods: Based on extensive binational experience and collaboration, from 2012–2014 we initiated two parallel, prospective, mixed methods studies: Proyecto El Cuete IV in Tijuana (n = 785) and the STAHR II Study in San Diego (n = 575). Methods for sampling, recruitment, and data collection were designed to be compatible in both studies. All participants completed quantitative behavioral and geographic assessments and serological testing (HIV in both studies; hepatitis C virus and tuberculosis in STAHR II) at baseline and four semi-annual follow-up visits. Between follow-up assessment visits, subsets of participants completed qualitative interviews to explore contextual factors relating to study aims and other emergent phenomena. Planned analyses include descriptive and inferential statistics for quantitative data, content analysis and other mixed-methods approaches for qualitative data, and phylogenetic analysis of HIV-positive samples to understand cross-border transmission dynamics. Results: Investigators and research staff shared preliminary findings across studies to provide feedback on instruments and insights regarding local phenomena. As a result, recruitment and data collection procedures have been implemented successfully, demonstrating the importance of binational collaboration in evaluating the impact of structural-level drug policy reforms on the behaviors, health, and wellbeing of PWID across an international border. Conclusions: Our prospective, mixed methods approach allows each study to be responsive to emerging phenomena within local contexts while regular collaboration promotes sharing insights across studies. The strengths and limitations of this approach may serve as a guide for other evaluations of harm reduction policies internationally

Transportation rating systems and social sustainability: A comprehensive analysis

The purpose of this study is to explore the social sector of sustainability in transportation design and engineering. Along with establishing a definition for social sustainability in transportation from existing literature, this document also includes a comprehensive analysis of current sustainability rating systems based on their evaluation of social sustainability metrics. The goal of this thesis is to inform transportation professionals about the existing social sustainability gaps in transportation literature and sustainability rating systems. Social sustainability in transportation is comprised of two fundamental concepts: social equity and sustainability of community (Bramley and Power, 2009; Dempsey, 2009; McKenzie, 2004; Magis, 2010; Vallance, 2011). Social equity includes accessibility, safety, and health, and sustainability of community includes cohesion, participation, and awareness. A coding system based on a hierarchical representation of social sustainability terminology was developed to categorize the credits of six sustainable transportation rating systems: Greenroads, I-LAST, Envision, INVEST, GreenPaths, and STARS. The results of this study indicate that gaps exist between the definition and application of social sustainability in transportation. Since research in this sector of sustainability is underdeveloped compared to economic and environmental sustainability, social objectives were largely underrepresented in Envision, Greenroads, and I-LAST. Using a qualitative framework was helpful in understanding where gaps exist since the credits were interpreted based on interrelated themes and descriptions. After evaluating how each rating system quantifies social sustainability objectives, it was determined that GreenPaths and STARS are most inclusive of social credits

Recognizing the influence of social determinants on HIV risk behaviors and the need for structural interventions to prevent HIV in women

The design and implementation of structural interventions may provide for simultaneous and longitudinal responses to prevention needs in multiple contexts as defined by social determinants, thus varied opportunities exist to respond to the HIV prevention needs of women. According to the CDC, in 2010, the rate of new HIV infections among black women was 20 times that of white women, and the rate among Hispanic/Latino women was 4 times the rate of white women. Additionally, 86% of HIV infections in women were attributed to heterosexual contact and 14% to injection drug use (CDC, 2012). These numbers are reflected outside the US with 49% of those infected by HIV being women with a predominant source of infection being related to heterosexual transmission (WHO, 2008). In sub-Saharan Africa, of those living with HIV, 60% are women. Attention to the influential context of social determinants of health provides unique opportunities for innovative prevention practice in HIV/AIDS prevention for women. In this paper, social determinants of health as an influential, behavioral concept is defined both in terms of women’s health and their sexual behavior decision making, along with examples of potential structural interventions that not only address the social determinants of their HIV risks but also reflect the contextual complexity of their life experiences. An earlier study (Abdul-Qader and Collins, 2011) solicited statements from a sample of experts in HIV prevention and areas of public health to identify potential structural interventions that would be feasible and impactful regarding HIV prevention - the DHAP Structural Interventions Mapping project. Data was elicited from these stakeholders most likely to be designing and guiding interventions to determine their perspectives on feasible and impactful structural intervention to address sexual behavior in women. The current paper is based on secondary analysis of 20 of these potential structural interventions generally and specifically applicable to women and their HIV prevention needs. Qualitative analysis resulted in three overall themes of economic interventions, response to violence against women and integrated health service delivery strategies that address key health-belief and socio-cultural issues. The themes are reflected and substantiated in current research literature, and provide a foundation for the next steps regarding research, policy planning and program implementation for developing evidence-based structural interventions focused on preventing HIV in women

Tradeoffs and entanglements among sustainability dimensions: the case of accessibility as a missing pillar of sustainable mobility policies in Italy.

Introduction Sustainable development clearly requires the integration of the economic, ecological, and social pillars. While scholars and practitioners have mainly approached sustainability from the standpoint of environmental protection and resource management, the social pillar has been a more limited part of the research agenda (Dillard et al. 2009), although it is generally recognized that "human well-being, equity, democratic government, and democratic civil society are central constituents of sustainability" (Magis & Shinn, 2009).The most compelling contributions about sustainability are mainly related to the concept of environmental justice (Leonard, 1989), in terms of both inequalities in access to environmental goods and unequal distribution of environmental risks (Beck, 1986). While democratic inclusion in the governance of sustainability has also received a great deal of attention (see, e.g., Hajer, 1995; Glasbergen, 1998; van Tatenhoven, 2003; Pellizzoni, 2010), social inequalities, justice, and inclusiveness have rarely been integrated into studies of sustainability (with some interesting exceptions, e.g., Polese & Stren 2001; Vrankenet et al. 2002; Magis & Shinn, 2009). There is, however, a broader and independent literature about the overlapping concepts of social cohesion and social exclusion (Pahl, 1991; Hopwoodet et al. 2005; Littig & Griessler, 2005; Dempsey et al. 2011; Ranci, 2011).1The main aims of this article are to highlight the relevance of an integrated approach to sustainability and to avoid possible tradeoff mechanisms among the different dimensions of this concept in the process of policy design and implementation. For instance, in a paradoxical way, initiatives oriented toward fostering mobility may lead to increases in environmental pollution while programs to contain the ecological impacts of mobility may undermine social justice and increase inequalities.Accessibility as a Wobbly Pillar of Sustainable Mobility To analyze possible tradeoff dynamics, this article discusses an even more important issue in the wider debate about sustainability: the challenges of fostering sustainable mobility. There are several reasons for growing attention to this issue, but most important is the idea that while mobility in one form or another has been essential throughout human history, in recent years it has undergone strong expansion and acceleration--of both people and goods--all around the globe (Urry, 2000). This development has been due to several drivers. First, a significant number of innovative technologies for transporting both people and goods, especially in the field of information technology and communication have encouraged greater mobility (Castells, 1996).2 Second, recent decades have seen an increase in freedom of movement within many political and territorial contexts such as Eastern Europe and Asia (Bauman, 1998). Finally, the spread of the free market and the growth of the international financial economy have gradually enveloped almost all of the planet's main economies, promoting a significant increase in the movement of raw materials, workers, and products (Sheller & Urry, 2006).These changing scenarios have promoted new mobility dynamics, with important environmental, economic, and social impacts.First, there is little doubt that mobility has important consequences for environmental protection, in terms of both natural resource consumption (e.g., raw materials, fuel, soil) and air and noise pollution. More specifically, motorized transportation can be divided roughly into four main modalities, of which waterways and railways have a lower environmental impact, while airways and roadways are more harmful in terms of both pollution and natural resource utilization (EU, 2009). As far as the environmental dimension of sustainability is concerned, it is clear that the extraordinary growth of the most ecologically problematic forms of transportation is responsible for a preponderant share of the challenges.

HIV Risks and Seroprevalence Among Mexican American Injection Drug Users in California

Latinos in the United States are an ethnically diverse group disproportionately affected by HIV/AIDS. We describe HIV seroprevalence, HIV risk behaviors and utilization of health services among Mexican American injection drug users (IDUs) in California (n = 286) and compare them to White (n = 830) and African American (n = 314) IDUs. Study participants were recruited from syringe exchange programs (n = 24) in California. HIV seroprevalence among Mexican Americans (0.5%) was dramatically lower than Whites (5%) and African Americans (8%). Mexican Americans reported fewer sex-related risks than Whites and African Americans though injection-related risks remained high. Compared to Whites, Mexican Americans were more likely to participate in drug treatment during a 6 month period (AOR 1.5, 95% CI 1.1, 2.0) but less likely to receive any health care (AOR 0.6, 95% CI 0.5, 0.8). Exploring cultural and structural factors among Mexican American IDUs may offer new insights into how to maintain low rates of HIV seroprevalence and reduce barriers to health care utilization