Benefits and constraints of intimate partnerships for HIV positive sex workers in Kibera, Kenya

INTRODUCTION: Research on the intimate partnerships of female sex workers (FSWs) tends to focus on the risks associated with these relationships. This paper takes as its starting point that the situation of FSWs is better understood by including knowledge of the benefits of their intimate partnerships. Specifically, we employ the conceptual framework provided by emergent research examining intimacy as a complex fusion of affective and instrumental dimensions among sex workers. This perspective allows us to frame information about FSWs’ intimate partnerships within a behaviour-structural approach that is helpful for identifying how intimate partnerships can be a source of both benefit as well as increased risk to FSWs. METHODS: Our results are based on a mixed-methods study carried out in the summer of 2011 in Kibera, Kenya. We conducted face-to-face interviews (n=30) with a non-probability sample of FSWs stratified by age who self-identified as Human Immune Virus positive (HIV+). We asked about participants’ involvement in current and past intimate partnerships, and whether these relationships had a positive or negative impact on their health and well‒being. RESULTS: Participants currently in intimate partnerships had fewer clients and thus lower incomes than those without intimate partnerships. Participants presently with partners were also more likely to receive some financial support from partners, to report lower intimate partner violence, and to narrate higher partner emotional support and greater assistance with medications. These participants were also more likely to have disclosed their sex work and HIV+ statuses to their partners. Intimate partnerships, on the other hand, showed increased risk of economic vulnerability and emotional dependence for FSWs. This became especially problematic for those participants in fragile relationships. Despite these variations, none of the differences between the two groups were statistically significant. CONCLUSIONS: Intimacy and transactional relations are bound up with one another and intersect with the structural realities and vulnerabilities; this is the case for sex workers in well-resourced and resourced-constrained countries alike. Rather than treating intimate partnerships as distinct from transactional relationships, FSWs’ relationships should be viewed on a continuum of risk and support

The Journey Experience of Visually Impaired People on Public Transport in London

The use of public transport is critical for Visually Impaired People (VIP) to be independent and have access to out-of-home activities. Despite government policies promoting accessible transport for everyone, the needs of VIP are not well addressed, and journeys can be very difficult to negotiate. Journey requirements can often differ from those of other categories of people on the disability spectrum. Therefore, the aim of this research is to evaluate the journey experience of VIP using public transport. Semi-structured interviews conducted in London are used. The results show that limited access to information, inconsistencies in infrastructure and poor availability of staff assistance are the major concerns. Concessionary travel, on the other hand, encourages VIP to make more trips and hence has a positive effect on well-being. The findings suggest that more specific policies should be introduced to cater to the special needs of particular disabilities rather than generalising the types of aids available. It is also concluded that the journey experience of VIP is closely related to an individual’s independence and hence inclusion in society

Replication of genome-wide association signals in UK samples reveals risk loci for type 2 diabetes

The molecular mechanisms involved in the development of type 2 diabetes are poorly understood. Starting from genome-wide genotype data for 1924 diabetic cases and 2938 population controls generated by the Wellcome Trust Case Control Consortium, we set out to detect replicated diabetes association signals through analysis of 3757 additional cases and 5346 controls and by integration of our findings with equivalent data from other international consortia. We detected diabetes susceptibility loci in and around the genes CDKAL1, CDKN2A/CDKN2B, and IGF2BP2 and confirmed the recently described associations at HHEX/IDE and SLC30A8. Our findings provide insight into the genetic architecture of type 2 diabetes, emphasizing the contribution of multiple variants of modest effect. The regions identified underscore the importance of pathways influencing pancreatic beta cell development and function in the etiology of type 2 diabetes.</p

Nå leser jeg med fingrene

I denne oppgaven har søkelyset vært rettet mot hvordan voksne personer som blir blinde opplever å lære seg å lese punktskrift. Formålet med denne oppgaven har vært å få innsikt i opplevelse og erfaring som de har gjort seg når de lærte den kunsten å lese med fingrene. I min studie velger jeg å se på hvordan blindblitte personer bruker sin leseerfaring og forkunnskap fra svartskriftlesing (trykte bokstaver) og hvordan de opplever og ser på overgangen mellom disse lesespråkene. Jeg tar også med hvordan din ser på sin motivasjon, selvoppfatning og mestring i en ny livssituasjon. Oppgavens problemstilling er følgende: Hvordan opplever blindblitte personer å lære seg punktskrift? Studien har tatt utgangspunkt i kvalitativ forskningstilnærming hvor datainnsamling har vært igjennom fem semistrukturert intervjuer med voksne blindblitte personer. Funnene som studien viser er at informanten hadde ulike forventninger til sitt første møte med fenomenet, noen var åpne og så med engang mulighetene den nye kunnskapen ville gi mens andre trengte mer tid. Informantene ga tydelig uttrykk for at de dro nytte av sitt forhold til trykte bokstaver og ord i overgangen mellom disse to lesespråkene. De fortalte grundig om sine erfaringer og hvordan de hadde gjort sammenligninger og assosiasjoner mellom svartskriftbokstaver og punktbokstaver. Motivasjon til å starte på opplæringen, positiv innstilling, tålmodighet og utholdenhet var også av stor betydning for mine informanter og viktig som drivkraft. Å delta i rehabiliteringsprogram og møte andre som var i lik situasjon betydde mye for dem. Ikke minst det å oppleve mestring, tilhørighet til gruppen og få informasjon og tilgang til det sosiale miljøet

Nå leser jeg med fingrene

I denne oppgaven har søkelyset vært rettet mot hvordan voksne personer som blir blinde opplever å lære seg å lese punktskrift. Formålet med denne oppgaven har vært å få innsikt i opplevelse og erfaring som de har gjort seg når de lærte den kunsten å lese med fingrene. I min studie velger jeg å se på hvordan blindblitte personer bruker sin leseerfaring og forkunnskap fra svartskriftlesing (trykte bokstaver) og hvordan de opplever og ser på overgangen mellom disse lesespråkene. Jeg tar også med hvordan din ser på sin motivasjon, selvoppfatning og mestring i en ny livssituasjon. Oppgavens problemstilling er følgende: Hvordan opplever blindblitte personer å lære seg punktskrift? Studien har tatt utgangspunkt i kvalitativ forskningstilnærming hvor datainnsamling har vært igjennom fem semistrukturert intervjuer med voksne blindblitte personer. Funnene som studien viser er at informanten hadde ulike forventninger til sitt første møte med fenomenet, noen var åpne og så med engang mulighetene den nye kunnskapen ville gi mens andre trengte mer tid. Informantene ga tydelig uttrykk for at de dro nytte av sitt forhold til trykte bokstaver og ord i overgangen mellom disse to lesespråkene. De fortalte grundig om sine erfaringer og hvordan de hadde gjort sammenligninger og assosiasjoner mellom svartskriftbokstaver og punktbokstaver. Motivasjon til å starte på opplæringen, positiv innstilling, tålmodighet og utholdenhet var også av stor betydning for mine informanter og viktig som drivkraft. Å delta i rehabiliteringsprogram og møte andre som var i lik situasjon betydde mye for dem. Ikke minst det å oppleve mestring, tilhørighet til gruppen og få informasjon og tilgang til det sosiale miljøet

A ten-year development of accessibility in the outdoor environment : Municipal challenges and older people’s perception

In an inaccessible outdoor environment, older people and people with disabilities can experience environmental barriers. The environmental barriers can restrict them and their abilities to walk. Environmental barriers can be avoided by designing the outdoor environment to meet the needs of older people and people with disabilities. This thesis focuses on accessibility in Sweden from two perspectives; societal challenges and user perception. It explores how the societal challenge of removing environmental barriers has been met and how removing environmental barriers can affect user perception ofthe outdoor environment. In Sweden, accessibility has been subjected to laws and regulations since the late fifties. In 1999 accessibility issues received increased attention through an action plan for disability policy. The implementation process has been somewhat monitored, showing that there are considerable differences in level of implemented accessibility policy in the municipalities. Studies exploring the impact of intervention in the outdoor environment are scarce. Such studies have, in most cases, focused on older people and the impact of interventions on their perception of the outdoor environment and frequency of walking. However, it is difficult to establish causal links in intervention studies with older people. During the implementation phase and until the after-study, older people age and ageing can have considerable impact on their perception of the environment. It is difficult to know whether changes in perception can be attributed to ageing or changes in the outdoor environment. Therefore, we need of studies that explore intervention studies over a long period. In this thesis, the societal challenge of removing environmental barriers (the Municipality Study), explores implementation of accessibility policy in municipal transport planning. The implementation process is explored through the eyes of municipal transport planners, with a mixed-method approach. The Municipality Study is based on a previously executed study. Therefore, the process of implementation of accessibility policy was explored in a longitudinal perspective. The level of implemented accessibility policy was quantified with indices. Then, municipalities were split into two groups, those that have increased their level of implemented accessibility policy ("ITOT”) and those that have increased their level of implemented accessibility policy (“D-TOT”). The user perception of the outdoor environment (the User Study), was explored through the eyes of older people, using a questionnaire. The User Study is based on a previously executed study, where an intervention was carried out in one neighbourhood (Study Area (SA)) in a middle-sized town in Sweden. The User Study explores the impact of an intervention by comparing perception of the outdoor environment with another area, reference area (RA) where no accessibility measures had been introduced. Furthermore, the User Study explores the impact of an intervention on older people’s perceptions of the outdoor environment in a longitudinal perspective. That is, while controlling for ageing. Results from the Municipality Study showed that there are considerable differences between municipalities regarding the implementation process of accessibility policy. “D-TOT” started early on implementing accessibility policy, only to reduce the efforts. “I-TOT” municipalities seem to have had later implementation starts. More municipalities have established accessibility plans and more have hired accessibility advisors. On the other hand, fewer municipalities cooperate with interest organisations, have a program for handicap polices and have implemented measures. The interviews indicated that reduced budget and staff time were among the factors restricting implementation of accessibility policy. On the other hand, employee enthusiasm for and interest in accessibility issues are among the main reasons that some municipalities progress and others regress in the implementation process. Interviews indicate that representatives from interest organisations are too focused on their own restrictions and do not represent the whole group’s perspective. This may be a reason why some municipalities have reduced cooperation with interest organisations. The interviews also indicated that some municipalities do not “suit actions to words”. That is, they establish accessibility plans and hire accessibility advisors, but do not utilise them. Some accessibility advisors are placed in the building department and do not have any influence in the transport department. Results from the User Study showed that interventions in the outdoor environment could have positive effects on older people’s perception. Respondents living in SA were more active in terms of frequency of participating in activities outside the home and frequency of walking. Furthermore, compared to respondents in RA, respondents in SA with poor perception of health were more likely to participate in activities than did their counterparts in RA. Respondents in SA and RA evaluated their outdoor environments in a similar manner. Still, the results also showed that respondents in SA reported more environmental barriers than did respondents in RA. Controlling for ageing, the results showed that intervention in the outdoor environment does not increase frequency of walking. However, intervention in the outdoor environment seems to have positive effects on older people’s perceptions of the outdoor environment. The respondents reported fewer environmental barriers in the outdoor environment nine years after an intervention in the outdoor environment than they did before the intervention. Furthermore, older people using mobility devices were more likely to be frequent walkers after the intervention. A more systematic approach is needed to fully implement accessibility in transport planning. Accessibility should not have to depend on the single employee who is enthusiastic and interested in accessibility. Accessibility should not be sensitive to employee turnover. Furthermore, results from the User Study showed that user perception of the outdoor environment could improve when barriers are removed. Therefore, municipalities should be implementing measures to improve accessibility. However, such measures should not be implemented simply to fulfil requirements of accessibility policy. Implementing measures in the outdoor environment should focus on the users and their needs. Municipalities should be cooperating with interest organisations. Meanwhile, representatives from the interest organisations should become more professional and represent the needs of all people with disabilities and not just their own needs. On the societal level, the results from this thesis give an indication that accessibility measures benefit people who are in need of further support from the environment. An environment designed to facilitate walking for people who are fragile is an environment that is accessible to all. A person carrying luggage, a person with a pram, a person who is temporarily experiencing disability, but more importantly people who are experiencing long-term disability and limitations, all benefit from an accessible outdoor environment. Even though accessibility issues are increasingly acknowledged in transport planning, there is still a need to raise awareness among transport planners and all actors involved in the accessibility work. It is important that all actors are aware of why accessibility measures are executed and how they should be executed, to ensure that the finalised measure gives the best result