Eurasian Future of Russia: Alternating Integration and Disintegration Cycles

Russia needs to fit into the international geopolitical and geo-economic landscape. The formation of this landscape is largely determined by alternating integration and disintegration cycles in the development of the world economy. The second global disintegration cycle that started in 2008 is expected to last 15—20 years. It will be followed by a new integration cycle, largely dependent on China (Pax Sinensis instead of Pax Americana). This change necessitates a number of steps: a significant strengthening of the Eastern vector in the development of Russia, the formation of the Moscow-Beijing-New Delhi triangle (Evgeny Primakov's idea) as well as providing access of energy-intensive and water-intensive goods from East Siberia by railway to the Chinese and Indian markets. Russia has expressed its interest in the construction of a railway from China to India. It will allow Russia to reduce transportation costs and use a potentially heavy transit traffic for the modernization of the Transsibirian railway. These steps could radically change the role of the Baltic exclave of Russia: from being a ‘window to Europe’ the region is to turn into the westernmost point of a infrastructure axis extending from east to west. The creation of such an axis, combined with a sharp fall in transportation costs will facilitate the access of energy-intensive and water-intensive goods from the Urals and Siberia to the Asian and European markets. The Kaliningrad region is increasingly taking on business facilitating functions, which used to be performed by the Soviet Baltic republics in the past. The region can play a more important role in the formation of Eurasia stretching from Shanghai to St. Petersburg (according to Dmitry Trenin), instead of the Europe from Lisbon to Vladivostok

Jean Gottmann as a Visionary and a Critic

This is an introductory paper to the special issue on “The spatial transformation of the urban environment in the conditions of post-industrial development of society” conference dedicated to the 100th anniversary of Jean Gottmann. The conference was held at the Institute of Environmental Management, territory development and urban planning of the Immanuel Kant Baltic Federal University, Kaliningrad, Russia. The special issue presents a number of scientific papers, which represent different view angles on regional development in the context of globalization. Keywords: Jean Gottmann, Economic Geography, Regional Economy, Kaliningrad Region JEL Classifications: N9, O1, R

Scaling Up Information Sharing on HIV-Associated Neurocognitive Disorder: Raising Awareness and Knowledge Among Key Stakeholders

Although the majority of specialists and researchers in the field of HIV/AIDS are aware and knowledgeable about HIV-associated neurocognitive disorder (HAND) as a condition that affects as much as 50% of people living with HIV/AIDS (PLWH), research has documented that many health care and service providers who work directly with PLWH are either unaware of HAND or believe they do not know enough information about HAND to effectively support their clients experiencing neurocognitive challenges. Based on the findings of a qualitative study that interviewed 33 health care and service providers in HIV/AIDS services to identify and examine their awareness and knowledge on HAND, this article argues for utilizing a combination of Public Health Informatics principles; communication techniques, propagation strategies, and recognized approaches from Implementation and Dissemination Science; and social media and online discussion platforms, in addition to traditional Knowledge Mobilization strategies, to scale up information sharing on HAND among all relevant stakeholders. Increasing information sharing among stakeholders would be an important step to raising awareness and knowledge on HAND, and consequently, improving care, services, and support for PLWH and neurocognitive issues

Sexual Risk Behaviour among HIV-Positive Individuals in Clinical Care in Urban KwaZulu-Natal, South Africa

Objectives: To assess the prevalence and predictors of unprotected sex among HIV+ individuals in clinical care in urban KwaZulu-Natal, South Africa. Design: Cross-sectional survey of 152 HIV+ individuals attending a hospital-based HIV-clinic. Methods: Structured interviews were conducted by bilingual interviewers. Sexual risk behaviour in the preceding 3 months was assessed via event counts. Results: In one of the first studies of its kind in South Africa we found that nearly half of the sample reported vaginal or anal sex during the preceding 3 months, and 30% of these patients reported unprotected vaginal or anal sex. Among sexually active patients, a total of 171 unprotected sex events were reported, 40% of which were with partners perceived to be HIV negative or HIV-status unknown. Nine such partners were potentially exposed to HIV. Alcohol use during sex, being forced to have sex, sex with a perceived HIV+ partner, and sex with a casual partner predicted more unprotected sex, whereas HIV-status disclosure was related to less unprotected sex. Conclusions: HIV+ individuals in clinical care in South Africa may engage in unprotected sex that place others at risk of HIV infection and themselves at risk for infection with STIs. With a national ARV rollout currently underway in South Africa, increasing numbers of HIV+ individuals are entering care. This affords a crucial opportunity to link HIV prevention with HIV care, an approach that aims to reduce transmission risk behaviour among HIV+ individuals and is consistent with international agencies’ current prevention priorities

Grand Challenges: Improving HIV Treatment Outcomes by Integrating Interventions for Co-Morbid Mental Illness.

In the fourth article of a five-part series providing a global perspective on integrating mental health, Sylvia Kaaya and colleagues discuss the importance of integrating mental health interventions into HIV prevention and treatment platforms. Please see later in the article for the Editors' Summary

An integrated dual process simulation model of alcohol use behaviours in individuals, with application to US population-level consumption, 1984–2012

Introduction The Theory of Planned Behaviour (TPB) describes how attitudes, norms and perceived behavioural control guide health behaviour, including alcohol consumption. Dual Process Theories (DPT) suggest that alongside these reasoned pathways, behaviour is influenced by automatic processes that are determined by the frequency of engagement in the health behaviour in the past. We present a computational model integrating TPB and DPT to determine drinking decisions for simulated individuals. We explore whether this model can reproduce historical patterns in US population alcohol use and simulate a hypothetical scenario, “Dry January”, to demonstrate the utility of the model for appraising the impact of policy interventions on population alcohol use. Method Constructs from the TPB pathway were computed using equations from an existing individual-level dynamic simulation model of alcohol use. The DPT pathway was initialised by simulating individuals’ past drinking using data from a large US survey. Individuals in the model were from a US population microsimulation that accounts for births, deaths and migration (1984–2015). On each modelled day, for each individual, we calculated standard drinks consumed using the TPB or DPT pathway. In each year we computed total population alcohol use prevalence, frequency and quantity. The model was calibrated to alcohol use data from the Behavioral Risk Factor Surveillance System (1984–2004). Results The model was a good fit to prevalence and frequency but a poorer fit to quantity of alcohol consumption, particularly in males. Simulating Dry January in each year led to a small to moderate reduction in annual population drinking. Conclusion This study provides further evidence, at the whole population level, that a combination of reasoned and implicit processes are important for alcohol use. Alcohol misuse interventions should target both processes. The integrated TPB-DPT simulation model is a useful tool for estimating changes in alcohol consumption following hypothetical population interventions

“Moving forward with life” : acceptability of a brief alcohol reduction intervention for people receiving antiretroviral therapy in South Africa

CITATION: Myers, B. et al. 2020. “Moving Forward with Life”: Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa. International Journal of Environmental Research and Public Health, 17(16). doi:10.3390/ijerph17165706The original publication is available at https://www.mdpi.com/journal/ijerphBackground: In South Africa, interventions are needed to address the impact of hazardous drinking on antiretroviral therapy among people living with HIV (PLWH). Participant feedback about these interventions can identify ways to enhance their acceptability. We interviewed participants in a randomized controlled trial of a brief motivational interviewing and problem-solving therapy (MI-PST) intervention about their perceptions of this alcohol-reduction intervention. Methods: The trial was conducted in HIV treatment clinics operating from six hospitals in the Tshwane region of South Africa. We conducted qualitative in-depth interviews with a random selection of participants. Twenty-four participants were interviewed after the final intervention session and 25 at the six-month follow up. Results: Participants believed that it was acceptable to offer PLWH, an alcohol reduction intervention during HIV treatment. They described how the MI-PST intervention had helped them reduce their alcohol consumption. Intervention components providing information on the health benefits of reduced consumption and building problem-solving and coping skills were perceived as most beneficial. Despite these perceived benefits, participants suggested minor modifications to the dosage, content, and delivery of the intervention for greater acceptability and impact. Conclusions: Findings highlight the acceptability and usefulness of this MI-PST intervention for facilitating reductions in alcohol consumption among PLWH.https://www.mdpi.com/1660-4601/17/16/5706/htmPublishers versio

Implementing Evidence-Based Alcohol Interventions in a Resource-Limited Setting: Novel Delivery Strategies in Tomsk, Russia

Effective implementation of evidence-based interventions in “real-world” settings can be challenging. Interventions based on externally valid trial findings can be even more difficult to apply in resource-limited settings, given marked differences—in provider experience, patient population, and health systems—between those settings and the typical clinical trial environment. Under the auspices of the Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis Patients (IMPACT) study, a randomized, controlled effectiveness trial, and as an integrated component of tuberculosis treatment in Tomsk, Russia, we adapted two proven alcohol interventions to the delivery of care to 200 patients with alcohol use disorders. Tuberculosis providers performed screening for alcohol use disorders and also delivered naltrexone (with medical management) or a brief counseling intervention either independently or in combination as a seamless part of routine care. We report the innovations and challenges to intervention design, training, and delivery of both pharmacologic and behavioral alcohol interventions within programmatic tuberculosis treatment services. We also discuss the implications of these lessons learned within the context of meeting the challenge of providing evidence-based care in resource-limited settings. (Harv Rev Psychiatry 2012;20:58–67.

HIV Prevention in Care and Treatment Settings: Baseline Risk Behaviors among HIV Patients in Kenya, Namibia, and Tanzania.

HIV care and treatment settings provide an opportunity to reach people living with HIV/AIDS (PLHIV) with prevention messages and services. Population-based surveys in sub-Saharan Africa have identified HIV risk behaviors among PLHIV, yet data are limited regarding HIV risk behaviors of PLHIV in clinical care. This paper describes the baseline sociodemographic, HIV transmission risk behaviors, and clinical data of a study evaluating an HIV prevention intervention package for HIV care and treatment clinics in Africa. The study was a longitudinal group-randomized trial in 9 intervention clinics and 9 comparison clinics in Kenya, Namibia, and Tanzania (N = 3538). Baseline participants were mostly female, married, had less than a primary education, and were relatively recently diagnosed with HIV. Fifty-two percent of participants had a partner of negative or unknown status, 24% were not using condoms consistently, and 11% reported STI symptoms in the last 6 months. There were differences in demographic and HIV transmission risk variables by country, indicating the need to consider local context in designing studies and using caution when generalizing findings across African countries. Baseline data from this study indicate that participants were often engaging in HIV transmission risk behaviors, which supports the need for prevention with PLHIV (PwP). TRIAL REGISTRATION: ClinicalTrials.gov NCT01256463