The Journey Home: Flight Related Factors on Refugee Decisions to Return

Normative practice for forced displacement is to voluntarily repatriate refugees once conditions are stable in the country of origin, which typically translates to the end of violence. However, Syrian refugees have been returning over the past few years even though there is yet to be a definitive end to the Syrian civil war. Therefore, this paper asks how refugees form decisions on when and whether they should return despite ongoing violence and instability in their country of origin? For now, we focus upon one part of the picture: how prior exposure to violence in the country of origin affects their subsequent decision to return home from their host country. To explore this relationship, we designed an original survey, implemented among Syrian refugees hosted in Lebanon (N=2,000), to causally identify the effects of prior conflict exposure on refugees’ decisions to return. We find that Syrian refugees are more willing to leave Lebanon and return home when they have prior experience of violence in Syria. We explain this initially counterintuitive finding as reflecting that they better understand their tolerance to violence, because they are “experts” and are more capable of assessing risk. In contrast, refugees who were not directly exposed to violence before fleeing their homes are more unsure of the threats associated to returning and are unwilling, therefore, to accept the risk of doing so

The Journey Home: Flight Related Factors on Refugee Decisions to Return

The international refugee regime promotes voluntary repatriation as the preferred solution to refugee crises. It is commonly held that it is safe for refugees to return once conditions are stable in the country of origin, which typically translates to when the violence between combatants ceases. However, the empirical record suggests that refugee returns are far from uniform in relationship to the presence or absence or level of violence in a conflict setting. In other words, we know remarkably little about the conditions under which refugee returns actually occur. In response to this shortfall in knowledge, we ask: how do refugees form decisions on when and whether they should return despite ongoing violence and instability in their country of origin? We focus upon one crucial part of the picture, in particular: how does prior exposure to violence in the country of origin affect refugees’ subsequent decisions to return? To explore this relationship, we designed an original survey, implemented among 2,000 Syrian refugees hosted in Lebanon to causally identify the effects of prior conflict exposure on refugees’ decisions to return. We find that Syrian refugees are more willing to leave Lebanon and return home when they have prior experience of violence in Syria. We explain this counter-intuitive finding as a reflection of these particular refugees as “experts” who are better able to understand and assess their risk tolerance of violence. In contrast, refugees more removed from violence before fleeing their homes harbor more uncertainty of the threats associated with returning and are unwilling to accept the risk of doing so

Recent HIV-1 Infection Contributes to the Viral Diffusion over the French Territory with a Recent Increasing Frequency

To analyse the contribution of primary human immunodeficiency virus type 1 (HIV-1) infection (PHI) to the French viral epidemic. sequences included 987 PHI from the French ANRS PRIMO cohort between 1999 and 2010 and were analysed using a population-based phylogenetic approach. Clinical features, risk factors, sexual behaviour and drug resistance for clustered and nonclustered transmission events were ascertained.Viruses from 125 (12.7%) of PHI cosegregated into 56 transmission chains, with increasing frequency during the last years (10.2% before 2006 versus 15.2% of clusters in 2006–2010, p = 0.02). The mean number of patients per cluster was 2.44. Compared to unique PHI, clusters involved more often men, infected through homosexual intercourse, of young age, with a high number of casual sexual partnerships and frequent previous HIV serological tests. Resistant strains were found in 16.0% and 11.1% of clusters and unique PHI, respectively (p = 0.11). Overall, 34% (n = 19) clusters included patients followed in French regions far apart, involving 13 clusters with at least one Parisian patient.PHIs are a significant source of onward transmission, especially in the MSM population. Recently infected people contribute to the spread of the viral epidemic throughout the French territory. Survey of transmitted drug resistance and behavioural characteristics of patients involved into clustered PHI may help to guide prevention and treatment interventions

CD4 cell count and the risk of AIDS or death in HIV-Infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE.

BACKGROUND: Most adults infected with HIV achieve viral suppression within a year of starting combination antiretroviral therapy (cART). It is important to understand the risk of AIDS events or death for patients with a suppressed viral load. METHODS AND FINDINGS: Using data from the Collaboration of Observational HIV Epidemiological Research Europe (2010 merger), we assessed the risk of a new AIDS-defining event or death in successfully treated patients. We accumulated episodes of viral suppression for each patient while on cART, each episode beginning with the second of two consecutive plasma viral load measurements 500 copies/µl, the first of two consecutive measurements between 50-500 copies/µl, cART interruption or administrative censoring. We used stratified multivariate Cox models to estimate the association between time updated CD4 cell count and a new AIDS event or death or death alone. 75,336 patients contributed 104,265 suppression episodes and were suppressed while on cART for a median 2.7 years. The mortality rate was 4.8 per 1,000 years of viral suppression. A higher CD4 cell count was always associated with a reduced risk of a new AIDS event or death; with a hazard ratio per 100 cells/µl (95% CI) of: 0.35 (0.30-0.40) for counts <200 cells/µl, 0.81 (0.71-0.92) for counts 200 to <350 cells/µl, 0.74 (0.66-0.83) for counts 350 to <500 cells/µl, and 0.96 (0.92-0.99) for counts ≥500 cells/µl. A higher CD4 cell count became even more beneficial over time for patients with CD4 cell counts <200 cells/µl. CONCLUSIONS: Despite the low mortality rate, the risk of a new AIDS event or death follows a CD4 cell count gradient in patients with viral suppression. A higher CD4 cell count was associated with the greatest benefit for patients with a CD4 cell count <200 cells/µl but still some slight benefit for those with a CD4 cell count ≥500 cells/µl

Trouble with Bleeding: Risk Factors for Acute Hepatitis C among HIV-Positive Gay Men from Germany—A Case-Control Study

OBJECTIVES: To identify risk factors for hepatitis C among HIV-positive men who have sex with men (MSM), focusing on potential sexual, nosocomial, and other non-sexual determinants. BACKGROUND: Outbreaks of hepatitis C virus (HCV) infections among HIV-positive MSM have been reported by clinicians in post-industrialized countries since 2000. The sexual acquisition of HCV by gay men who are HIV positive is not, however, fully understood. METHODS: Between 2006 and 2008, a case-control study was embedded into a behavioural survey of MSM in Germany. Cases were HIV-positive and acutely HCV-co-infected, with no history of injection drug use. HIV-positive MSM without known HCV infection, matched for age group, served as controls. The HCV-serostatus of controls was assessed by serological testing of dried blood specimens. Univariable and multivariable regression analyses were used to identify factors independently associated with HCV-co-infection. RESULTS: 34 cases and 67 controls were included. Sex-associated rectal bleeding, receptive fisting and snorting cocaine/amphetamines, combined with group sex, were independently associated with case status. Among cases, surgical interventions overlapped with sex-associated rectal bleeding. CONCLUSIONS: Sexual practices leading to rectal bleeding, and snorting drugs in settings of increased HCV-prevalence are risk factors for acute hepatitis C. We suggest that sharing snorting equipment as well as sharing sexual partners might be modes of sexual transmission. Condoms and gloves may not provide adequate protection if they are contaminated with blood. Public health interventions for HIV-positive gay men should address the role of blood in sexual risk behaviour. Further research is needed into the interplay of proctosurgery and sex-associated rectal bleeding

Bridge Overstress Criteria

DFTH-61-88-C-00096This report presents a reliability-based procedure to determine the optimal allowable loads on highway bridges considering both static and dynamic effects. A truck weight (bridge) formula was developed to provide acceptable levels of safety for bridges designed according to the 15th edition of the AASHTO specifications. Using the safety index as a measure of safety, the truck weight formula was developed to produce a safety index value of 2.5. Twelve bridges of different material types, span lengths and configurations were analyzed for truck loads corresponding to the proposed truck weight formula. The results of the rating evaluation of these bridges showed large variations between the rating values for LFD and WSD procedures and inventory or operating stresses. Application of the higher truck weight limits to a large sample of bridges from the National Bridge Inventory indicated an increase in the number of deficient bridges if the inventory rating stress is used in the evaluation procedure. However, very few of the existing bridges would be considered deficient if the operating ratings are used. A fatigue analysis determined the relative fatigue damage caused by various new truck types and traffic scenarios that might result from changes in truck regulations. The fatigue calculations for actual bridges suggest that many existing bridges would not be affected by the possible truck regulation changes. Even for bridges with fatigue stresses above the fatigue limit, the reduced fatigue lives with the new regulations may still be sufficient for practical requirements