Antiretroviral Treatment Knowledge and Stigma--Implications for Programs and HIV Treatment Interventions in Rural Tanzanian Populations.

To analyse antiretroviral treatment (ART) knowledge and HIV- and ART-related stigma among the adult population in a rural Tanzanian community. Population-based cross-sectional survey of 694 adults (15-49 years of age). Latent class analysis (LCA) categorized respondents' levels of ART knowledge and of ART-related stigma. Multinomial logistic regression assessed the association between the levels of ART knowledge and HIV- and ART-related stigma, while controlling for the effects of age, gender, education, marital status and occupation. More than one-third of men and women in the study reported that they had never heard of ART. Among those who had heard of ART, 24% were east informed about ART, 8% moderately informed, and 68% highly informed. Regarding ART-related stigma, 28% were least stigmatizing, 41% moderately stigmatizing, and 31% highly stigmatizing toward persons taking ART. Respondents that had at least primary education were more likely to have high levels of knowledge about ART (OR 3.09, 95% CI 1.61-5.94). Participants highly informed about ART held less HIV- and ART-related stigma towards ART patients (OR 0.26, 95% CI 0.09-0.74). The lack of ART knowledge is broad, and there is a strong association between ART knowledge and individual education level. These are relevant findings for both HIV prevention and HIV treatment program interventions that address ART-related stigma across the entire spectrum of the community

No one knows what will happen after these five years': narratives of ART, access and agency in Nigeria

Rural Nigerians pursue a range of strategies to maximize current and future access to HIV treatment in the context of securing livelihoods and minimizing the social and economic risks of stigma. This study reports on qualitative interviews with service providers and anti-retroviral therapy (ART) patients accessing care in Benue State, Nigeria, or travelling several hours to Abuja for treatment (n = 34). Nigerians living with HIV are keenly aware of the fragility and complex global and local politics of funding. Their narratives of pervasive stigma, economic and health system barriers to access, growing fears that free ART will cease, and strategies to secure access to care reveal a sophisticated synthesis of social determinants of health and clinical care, and challenge practitioners, planners, and scholars to take a similarly robust and nuanced approach to vulnerability, access, and agency.Department of HE and Training approved lis

Women's Preferences Regarding Infant or Maternal Antiretroviral Prophylaxis for Prevention of Mother-To-Child Transmission of HIV during Breastfeeding and Their Views on Option B+ in Dar es Salaam, Tanzania.

The WHO 2010 guidelines for prevention of mother-to-child transmission (PMTCT) of HIV recommended prophylactic antiretroviral treatment (ART) either for infants (Option A) or mothers (Option B) during breastfeeding for pregnant women with a CD4 count of >350 cell/µL in low-income countries. In 2012, WHO proposed that all HIV-infected pregnant women should receive triple ART for life (B+) irrespective of CD4 count. Tanzania has recently switched from Option A to B+, with a few centers practicing B. However, more information on the real-life feasibility of these options is needed. This qualitative study explored women's preferences for Option A vs B and their views on Option B+ in Dar es Salaam, Tanzania. We conducted four focus group discussions with a total of 27 pregnant women with unknown HIV status, attending reproductive and child health clinics, and 31 in-depth interviews among HIV-infected pregnant and post-delivery women, 17 of whom were also asked about B+. Most participants were in favor of Option B compared to A. The main reasons for choosing Option B were: HIV-associated stigma, fear of drug side-effects on infants and difficult logistics for postnatal drug adherence. Some of the women asked about B+ favored it as they agreed that they would eventually need ART for their own survival. Some were against B+ anticipating loss of motivation after protecting the child, fearing drug side-effects and not feeling ready to embark on lifelong medication. Some were undecided. Option B was preferred. Since Tanzania has recently adopted Option B+, women with CD4 counts of >350 cell/µL should be counseled about the possibility to "opt-out" from ART after cessation of breastfeeding. Drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness

A Single-Blind randomized controlled trial to evaluate the effect of extended counseling on uptake of pre-antiretroviral care in eastern uganda

<p>Abstract</p> <p>Background</p> <p>Many newly screened people living with HIV (PLHIV) in Sub-Saharan Africa do not understand the importance of regular pre-antiretroviral (ARV) care because most of them have been counseled by staff who lack basic counseling skills. This results in low uptake of pre-ARV care and late treatment initiation in resource-poor settings. The effect of providing post-test counseling by staff equipped with basic counseling skills, combined with home visits by community support agents on uptake of pre-ARV care for newly diagnosed PLHIV was evaluated through a randomized intervention trial in Uganda.</p> <p>Methods</p> <p>An intervention trial was performed consisting of post-test counseling by trained counselors, combined with monthly home visits by community support agents for continued counseling to newly screened PLHIV in Iganga district, Uganda between July 2009 and June 2010, Participants (N = 400) from three public recruitment centres were randomized to receive either the intervention, or the standard care (the existing post-test counseling by ARV clinic staff who lack basic training in counseling skills), the control arm. The outcome measure was the proportion of newly screened and counseled PLHIV in either arm who had been to their nearest health center for clinical check-up in the subsequent three months +2 months. Treatment was randomly assigned using computer-generated random numbers. The statistical significance of differences between the two study arms was assessed using chi-square and t-tests for categorical and quantitative data respectively. Risk ratios and 95% confidence intervals were used to assess the effect of the intervention.</p> <p>Results</p> <p>Participants in the intervention arm were 80% more likely to accept (take up) pre-ARV care compared to those in the control arm (RR 1.8, 95% CI 1.4-2.1). No adverse events were reported.</p> <p>Conclusions</p> <p>Provision of post-test counseling by staff trained in basic counseling skills, combined with home visits by community support agents had a significant effect on uptake of pre-ARV care and appears to be a cost-effective way to increase the prerequisites for timely ARV initiation.</p> <p>Trial registration</p> <p>The trial was registered by Current Controlled Trials Ltd C/OBioMed Central Ltd as <a href="http://www.controlled-trials.com/ISRCTN94133652">ISRCTN94133652</a> and received financial support from Sida and logistical support from the European Commission.</p

Specifika läs- och skrivsvårigheter ur ett pedagogiskt perspektiv - att upptäcka, utreda och åtgärda.

Sammanfattning: I vår uppsats har vi studerat området specifika läs- och skrivsvårigheter. Uppsatsen syftar till att belysa hur pedagoger förhåller sig till dessa svårigheter och hur arbetet med dessa elever genomförs. I arbetet synliggörs de pedagogiska insatser som eleven är i behov av för att få en gynnsam språkutveckling. Syftet är att lyfta pedagogernas uppfattningar om bakomliggande faktorer till specifika läs- och skrivsvårigheter och hur problematiken upptäcks, utreds och åtgärdas. Vi har genomfört intervjuer med specialpedagoger och pedagoger för att kunna ställa praktik i förhållande till teori. Deras svar har legat till grund för vår uppsats. Resultatet visade att tidiga insatser, motivation, individanpassat material och individanpassad undervisning ansågs vara avgörande för en god utveckling hos eleven. Vidare visade resultatet att pedagogerna framförallt framhöll tre bakomliggande faktorer till specifika läs- och skrivsvårigheter: det genetiska arvet, uppväxtmiljöns betydelse och pedagogiska insatser. Även om det pedagogiska arbetet är beroende av resurser har vi genom intervjuerna sett att man med små tillgångar kan uträtta mycket genom att vara en medveten pedagog. Med detta menar vi att man som pedagog gör medvetna val och anpassar undervisningen efter elevens behov.

Estonia's health geography : West versus east - an ethnic approach

The purpose with this essay is to explore the social changes in relation to changes in mortality for the two largest ethnic groups in Estonia; ethnic Estonians and the Russian minority. Since this is a geographical essay, my purpose is also to explore these changes in relation to the country’s internal geography. As these changes appear over time in space, the content is partly rooted in a time geographical point of view. It is also rooted in a regional geographical point of view, since I have been comparing the mentioned changes between different areas in Estonia (with considerations on developments abroad). Two different development lines can be seen as a consequence of the social changes taking place in the 1990s. While the ethnic Estonians situation has improved, the Russian minority’s situation has instead declined regarding to social existence and health. As a result the mortality has increased enormously for the Russian minority. The ethnic Estonians had also a mortality increase in practically all studied causes of death in all studied areas, but this increase wasn’t as high as for the Russian minority. Nevertheless, when comparing two different counties with each other as well as with the country as whole, the pattern seems to be more complicated. The Russians living in the western county of Läänemaa, have been affected more favourably by the social change than those living in the north-eastern county of Ida-Virumaa. Except for mortality by alcohol poisoning, the Russians living in Läänemaa had a much lower mortality increase than those living in Ida-Viruma and even compared with the country as whole. It seems as those Russians living in the western parts of Estonia have been affected more favourably than those living in the north-eastern parts. These structures are very much depending on the history, since most of the Russians living in the north-eastern area immigrated during the Soviet era, while the western parts had a much earlier immigration of Russians. Considering the time and place of the Russian immigration, one can divide the Russian minority in two groups; those in the west, and those in the east

The Integration of Ethiopian immigrants in Sweden, 1990-2000

The main purpose of this Master Essay is to analyse the integration of Ethiopian immigrants in Sweden between 1990 and 2000. My hypothesis has been that Ethiopian immigrants in Sweden constitute a group whose prospects to integrate are fairly low, but whose prospects to integrate also depend on the sex-composition and the length of staying in Sweden. In my analysis of the chosen group’s immigration pattern and integration, I have used a longitudinal database of the Swedish population where information on income and employment are included. I have analysed the group’s labour market participation and their prospects to reduce and eventually close the income gap in relation to the working aged population in Sweden. The regime of control in Ethiopia between 1977 and 1991 forced hundreds of thousands of mostly young Ethiopians to flee to Europe and USA. Between 1985 and 2000, 8033 Ethiopians immigrated to Sweden. The peak years were 1989 and 1991, preceded by a dramatic increase of the number of Ethiopians who immigrated to Sweden. After 1991 the immigration from Ethiopia to Sweden declined rapidly to a similarly low level as before 1985. Nevertheless, when analysing the age-composition, those aged 18-29 years were shown to be in majority throughout the whole period as mostly young Ethiopians were forced to flee before 1991. Also, younger persons are more likely to migrate than older persons. The spectacular decrease of Ethiopian immigration to Sweden was probably linked to the former regime’s capitulation in 1991. In addition, Eritrea’s outbreak from Ethiopia in 1991 also had consequences on the numbers of Ethiopian immigrants to Sweden as Eritreans were no longer categorized as Ethiopians. Up to 1991, men were more likely to immigrate, but after then females were clearly in majority. The frequency of not being employed has decreased considerably among Ethiopian immigrants throughout the period. At the same time, the income gap between them and the population in general was reduced even though it remained large in the whole period. The decrease in the proportion of Ethiopian immigrants without employment was larger for the females than for the males, and even if men had higher incomes throughout the period, women’s income approached that. Thus it seems that the integration process is on its way for Ethiopian immigrants, especially for the women. The age-composition is probably an important factor behind the group’s relatively successful integration given the large share of working aged persons

Portfolio som arbetsredskap i skolan. : En studie kring portfolio och dataprogrammet Portfolio Manager 2.

Portfoliometodik är idag ett känt begrepp, likaså digital elevportfolio. Båda dessa begrepp, och en av de programvaror som främst är utvecklade för att vara en aktiv digital elevportfolio, har en central roll i den här studien. Portfolio Manager 2, som programmet i fråga heter, är utvecklat i Sverige av svenska pedagoger. Studien har en kvantitativ ansats med enkäter som redskap. En köns- och specialpedagogisk betraktelsegrund fanns i studien, vilket också resulterade i nya pedagogiska rön. Studien är utförd i 5 klasser på 2 olika svenska skolor i slöjd, där samtliga elever gick i åk 5. Lärarenkäten var utformad så att den skulle kunna ge en bedömning av ”fenomenet” PM2 som helhet, då PM2 även innehåller verktyg av det mer administrativa slaget. Studiens resultat bekräftar tidigare studier, dvs. att elevportfolio bidrar positivt till att stärka den pedagogiska lärandeprocessen. Ett nytt rön som framträder i studien, är att flickor i högre grad än pojkar i åk 5, inser portfoliometodikens betydelse för lärandeprocessen. Resultatet visar även att programvaran Portfolio Manager 2 är väl användaranpassat, både som redskap för digital elevportfolio och som ett läraradministrativt redskap. Ämnet slöjd är inte ett primärt studieobjekt, men omskrivs kort i studien utifrån den ”överskottsinformation” enkäterna gav. Resultatet för slöjdämnet var positivt. Titel: Portfolio som arbetsredskap i skolan - En studie kring portfolio och dataprogrammet Portfolio Manager 2. Nivå: C uppsats Författare: Lärare i Specialpedagogik, Mats Agnarson - Karlstad. Handledare: Hugo Wikström, Karin Bengtsson – Karlstads Universitet. Examinator: Anders Arnqvist – Karlstads UniversitetPortfolio methodology and digital portfolio for pupils are nowadays well known conceptions. These two things, just as one of the computer programmes developed in purpose to be an active digital portfolio for pupils, have an essential part of this study. Portfolio Manager 2, which is the name of the programme, is developed in Sweden, by Swedish pedagogues. The study has a quantitative disposition, with questionnaires as instrument. A gender and special needs approach was part of the study, which resulted in new pedagogical experiences. The study was made at 2 different Swedish schools, in 5 classes in form 5. The subject was woodworks and textile craft. The teacher questionnaire was shaped in such a manner that it could provide a judgement of the “phenomena” PM2 as a unit, since PM2 also consists from tools of the more administrative kind. The result of the study corroborates earlier studies, which was that the use of portfolio helps pupils in their learning process. The study also shows that girls in form 5, more than boys in the same age group, understand the connection between learning and portfolio methodology. Further more this examination points out that the software Portfolio Manager 2 is very user-friendly, both for pupils using digital portfolio as well as for teachers as an administrative tool. The school subject woodworks and textile craft is not the primary object of the study, but is discussed in the text through the “excess information” from the questionnaires. The result regarding the school subject woodworks and textile craft was positive. Title: Portfolio as a working tool in school – A study concerning portfolio and the computer programme Portfolio Manager 2 Level: C Writer: Pedagogue Mats Agnarson – Karlstad Supervisor: Hugo Wikström, Karin Bengtsson – Karlstads Universitet Examinator: Anders Arnqvist – Karlstads Universite