Building a Culture of Retirement: Class, Politics and Pensions in Post-World War II Ontario

This paper examines four factors which influenced the development of old age pensions in Canada after World War II. The legacy of Canada's original means-tested pension program, the class politics of pension bargaining between business and organized labour on both sides of the border, the policy example of Social Security in the United States, and the key importance of the insurance and investment industry lobby operating through successive Conservative governments in Ontario, are highlighted as critical factors which affected the timing and limited the scope of Canada's public pension system. The residualist design of Old Age Security in 1951 and Ontario's success in gaining a veto over reforms to the Canada Pension Plan in 1965 are singled out as a key factors behind the current vulnerability of Canadian public pensions to fiscal cutbacks compared to the Social Security in the United States.Le présent texte analyse quatre des facteurs qui ont influencé la mise en place d'un régime de pensions de vieillesse au Canada après la Deuxième Guerre mondiale. Ces facteurs décisifs qui ont déterminé le calendrier d'application du régime de pensions de l'État et qui en ont limité la portée sont les suivants : le legs du premier programme de pensions de vieilesse du pays, fondé sur des enquêtes sur les ressources des bénéficiaires, le jeu des politiques de classe dans les négociations relatives à la pension opposant le monde des affaires à celui de la main-d'oeuvre syndiquée de chaque côté de la frontière, l'exemple du modèle américain en matière de sécurité sociale, et l'importance majeure du lobby des sociétés d'assurance et d'investissement auprès des gouvernements conservateurs successifs en Ontario. Si les régimes de pensions canadiens sont actuellement plus vulnérables aux compressions budgétaires que les programmes de sécurité sociale des États-Unis, c'est entre autres et surtout parce que le programme d'assistance aux vieillard dans le besoin a été élaboré à partir d'un projet résiduel et parce que l'Ontario a réussi à obtenir en 1965 un droit de veto sur les réformes du régime de pensions du Canada

“Lord give us men”: Women and Social Work in English Canada, 1918 to 1953

Depuis la dernière décennie, les travailleurs sociaux du Canada sont aux prises avec un embarrassant paradoxe: bien que les femmes aient été les pionnières dans la profession et qu'elles représentent près de soixante pour cent des effectifs dans le domaine, les hommes y occupent les meilleurs postes, tant dans l'enseignement que dans l'administration, et, à travail égal, ils commandent de meilleurs salaires. Des études récentes effectuées dans plusieurs provinces canadiennes en témoignent éloquemment et il en est de même, d'ailleurs, aux Etats-Unis. Ainsi, et curieuse- ment, il appert donc qu'en dépit du fait que les membres de cette profession s'enorgueillissent d'avoir été à l'avant-garde de nombreuses transformations sociales, le sexisme qui sévit dans la répartition du travail au sein de la profession ne fait que refléter les inégalités qui existent toujours dans notre société.L'auteur s'interroge ici sur les origines de ces inégalités, sur les raisons qui ont empêché les femmes de s'emparer des postes les plus rémunérateurs, sur la perception qu'avaient ces femmes du rôle de la femme dans la société et, enfin, sur l'incidence que ces deux dernières questions ont pu exercer l'une sur l'autre. A travers l'étude des événements qui ont marqué la profession dans les décennies vingt à quarante, il constate que non seulement les hommes ont dominé dans la profession mais que, bien souvent, ces hommes qui étaient beaucoup mieux rémunérés que les femmes qu'ils dirigeaient étaient à la fois plus jeunes et moins bien formés qu'elles. A cet égard, le travail social ressemblait fort aux autres professions féminines à l'époque à cette différence près, toutefois, que les travailleuses sociales protestaient en somme contre une image de la femme qu'elles avaient, d'une certaine façon, contribué à maintenir et qu'elles s'opposaient à une domination masculine qu'elles avaient elles-mêmes encouragée à une certaine époque, préoccupées qu'elles étaient alors de rehausser l'image de la profession aux yeux de la société

Regulating the Elderly: Old Age Pensions and the Formation of a Pension Bureaucracy in Ontario, 1929-1945

This article examines the emergence of means-tested old age pensions in Ontario in the context of the Great Depression and World War II. Ontario's old age pension scheme, it argues, was launched in 1929 with weak political commitment, little bureaucratic-preparation, and an almost complete absence of administrative experience at the provincial and municipal level in assessing and responding to need on a mass scale. The article examines the complex interplay among federal, provincial, and local government authorities in the politics of pension administration throughout the 1929-1945 era, arguing that local control of pension decision-making in the early years of the Depression provided two divergent models of pension entitlement both as charity and as an earned social right. After 1933 governments at both the provincial and federal level centralized decision-making over pension administration in order to standardize and restrict pension entitlement, contain its rapidly rising costs, and enforce more efficiently the concept of parental maintenance upon children. World War II undermined the concept of pensions as charity by broadly expanding the boundaries of entitlement both for the elderly and their children. By 1945 means-tested pensions had few supporters within or outside of government, laying the basis for the emergence of a universal system of old age security in 1951.Cet article porte sur les premières années de l'histoire des pensions de vieillesse après enquête financière sur les ressources (means-tested) versées aux Ontariens durant la Crise et la Deuxième Guerre mondiale. Il tente de montrer que c'est avec peu de conviction politique que le programme de pensions ontarien fut mis en vigueur en 1929 : peu e préparation bureaucratique et un contexte, tant au niveau provincial qu'au niveau municipal, d'absence quasi totale de l'expérience administrative nécessaire à la mise sur pied d'un mécanisme massif d'évaluation des besoins et de réponse à ceux-ci. Un examen des relations complexes entre les autorités fédérales, provinciales et municipales mises en branle dans les premières quinze années du programme montre qu'au cours des premières années de la Crise, les autorités locales contrôlèrent les décisions d'allocations de pensions et ce selon deux modèles divergents, celui de la charité et celui des droits sociaux acquis. Après 1933 cependant, les gouvernements provincial et fédéral centralisèrent et uniformisèrent le processus de décision en vue tout à la fois de réduire le nombre des prestations, de contrôles l'accroissement rapide des coûts du programme et, pour ce faire, de redonner vigueur à l'idée de l'obligation qu'ont les enfants d'entretenir leurs parents. Au cours de la Deuxième Guerre mondiale, l'idée d'associer ces pensions à la charité perdit des plumes alors que les conceptions des droits des enfants et des personnes âgés gagnèrent en popularité. Après 1945, les enquête financières sur les ressources (means-tests) ne récoltaient plus qu'un support minime chez les membres du gouvernement et dans l'ensemble de la population, si bien que les fondements de l'émergence du système de pension universel de 1951 étaient jetées

Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report

BACKGROUND:Prepubertal gynecomastia is a rare condition and most frequently classified as idiopathic. In HIV-infected adults gynecomastia is a recognised but infrequent side-effect of antiretroviral treatment (ART) and mostly attributed to efavirenz use. Gynecomastia should be distinguished from pseudogynecomastia as part of the lipodystrophy syndrome caused by Nucleoside Reverse Transcriptase Inhibitors (NRTIs) to avoid incorrect substitution of drugs. In the medical literature only five cases of prepubertal gynecomastia in children taking ART are described and underlying pathogenesis was unknown. The occurrence of adverse effects of ART may interfere with therapy adherence and long-term prognosis and for that reason requires attention. We report the first case of prepubertal gynecomastia in a young girl attributed to efavirenz use.CASE PRESENTATION:A seven-year-old African girl presented with true gynecomastia four months after initiation on ART (abacavir, lamivudine, efavirenz). History, physical examination and laboratory tests excluded known causes of gynecomastia and efavirenz was considered as the most likely cause. Six weeks after withdrawal of efavirenz the breast enlargement had completely resolved. CONCLUSIONS: Efavirenz-induced gynecomastia may occur in children as well as in adults. With the increasing access to ART, the possibility of efavirenz-exposure and the potential occurrence of its associated side-effects may be high. In resource-poor settings, empirical change from efavirenz to nevirapine may be considered, providing no other known or alarming cause is identified, as efavirenz-induced gynecomastia can resolve quickly after withdrawal of the drug. Timely recognition of gynecomastia as a side-effect of efavirenz is important in order to intervene while the condition may still be reversible, to sustain adherence to ART and to maintain the sociopsychological health of the child

Linking the global positioning system (GPS) to a personal digital assistant (PDA) to support tuberculosis control in South Africa: a pilot study

BACKGROUND: Tuberculosis (TB) is the leading clinical manifestation of HIV infection and caseloads continue to increase in high HIV prevalence settings. TB treatment is prolonged and treatment interruption has serious individual and public health consequences. We assessed the feasibility of using a handheld computing device programmed with customised software and linked to a GPS receiver, to assist TB control programmes to trace patients who interrupt treatment in areas without useful street maps. In this proof of concept study, we compared the time taken to re-find a home comparing given residential addresses with a customised personalised digital assistant linked to a global positioning system (PDA/GPS) device. Additionally, we assessed the feasibility of using aerial photographs to locate homes. RESULTS: The study took place in two communities in Greater Johannesburg, South Africa: Wheillers Farm, a relatively sparsely populated informal settlement, and a portion of Alexandra, an urban township with densely populated informal settlements. Ten participants in each community were asked to locate their homes on aerial photographs. Nine from Wheillers Farm and six from Alexandra were able to identify their homes. The total time taken by a research assistant, unfamiliar with the area, to locate 10 homes in each community using the given addresses was compared with the total time taken by a community volunteer with half an hour of training to locate the same homes using the device. Time taken to locate the ten households was reduced by 20% and 50% in each community respectively using the PDA/GPS device. CONCLUSION: In this pilot study we show that it is feasible to use a simple PDA/GPS device to locate the homes of patients. We found that in densely populated informal settlements, GPS technology is more accurate than aerial photos in identifying homes and more efficient than addresses provided by participants. Research assessing issues of, confidentiality and cost effectiveness would have to be undertaken before implementing PDA/GPS – based technology for this application. However, this PDA/GPS device could be used to reduce part of the burden on TB control programs

Towards 'men who have sex with menappropriate' health services in South Africa

Health programming for men who have sex with men (MSM) in South Africa has been ignored or absent until fairly recently, despite this population being at high risk for HIV acquisition and transmission. Anova Health Institute, with support from the US President's Emergency Plan for AIDS Relief (PEPFAR)/United States Agency for International Development (USAID) and in collaboration with the South African National Department of Health, launched the first state sector MSM-targeted sexual health clinic in 2010. The clinic has been successful in attracting and retaining MSM in care, and lessons learned are described in this article. Components contributing to the creation of MSM-appropriate healthcare services are discussed

The prevalence of human papillomavirus infections and associated risk factors in men-who-have-sex-with-men in Cape Town, South Africa

Abstract Background We investigated the prevalence of human papillomavirus (HPV) infection and associated behavioural risk factors in men-who-have-sex-with-men (MSM) attending a clinical service in Cape Town, South Africa. Methods MSM were enrolled at the Ivan Toms Centre for Men’s Health in Cape Town. A psychosocial and sexual behavioral risk questionnaire was completed for each participant and urine, oro-pharyngeal and anal swabs were collected for HPV testing using the Linear Array HPV Genotyping Test. Logistic regression analyses were performed to determine sexual risk factors associated with HPV infection at the three anatomical sites. Results The median age of all 200 participants was 32 years (IQR 26-39.5), of which 31.0 % were black, 31.5 % mixed race/coloured and 35.5 % white. The majority of the participants (73.0 %) had completed high school, 42.0 % had a tertiary level qualification and 69.0 % were employed. HPV genotypes were detected in 72.8 % [95 % CI: 65.9–79.0 %], 11.5 % [95 % CI: 7.4–16.8 %] and 15.3 % [95 % CI: 10.5–21.2 %] of anal, oro-pharyngeal and urine specimens, respectively. Prevalence of high-risk (HR)-HPV types was 57.6 % [95 % CI: 50.3–64.7 %] in anal samples, 7.5 % [95 % CI: 4.3–12.1 %] in oro-pharyngeal samples and 7.9 % [95 % CI: 4.5–12.7 %] in urine, with HPV-16 being the most common HR-HPV type detected at all sites. HPV-6/11/16/18 was detected in 40.3 % [95 % CI: 33.3–47.6 %], 4.5 % [95 % CI: 2.1–8.4 %] and 3.2 % [95 % CI: 1.2–6.8 %] of anal, oro-pharyngeal and urine samples, respectively. Multiple HPV types were more common in the anal canal of MSM while single HPV types constituted the majority of HPV infections in the oropharynx and urine. Among the 88 MSM (44.0 %) that were HIV positive, 91.8 % [95 % CI: 83.8–96.6 %] had an anal HPV infection, 81.2 % [95 % CI: 71.2–88.8 %] had anal HR-HPV and 85.9 % [95 % CI: 76.6–92.5 %] had multiple anal HPV types. Having sex with men only, engaging in group sex in lifetime, living with HIV and practising receptive anal intercourse were the only factors independently associated with having any anal HPV infection. Conclusions Anal HPV infections were common among MSM in Cape Town with the highest HPV burden among HIV co-infected MSM, men who have sex with men only and those that practiced receptive anal intercourse. Behavioural intervention strategies and the possible roll-out of HPV vaccines among all boys are urgently needed to address the high prevalence of HPV and HIV co-infections among MSM in South Africa

A cross sectional analysis of Gonococcal and Chlamydial infections among men-who-have-sex-with-men in Cape Town, South Africa

BACKGROUND: Men-who-have-sex-with-men (MSM) are at high risk of HIV and sexually transmitted infection (STI) transmission. Asymptomatic STIs are common in MSM and remain undiagnosed and untreated where syndromic management is advocated. Untreated STIs could be contributing to high HIV rates. This study investigated symptomatic (SSTI) and asymptomatic STIs (ASTIs) in MSM in Cape Town. METHODS: MSM, 18 years and above, were enrolled into this study. Participants underwent clinical and microbiological screening for STIs. Urine, oro-pharyngeal and anal swab specimens were collected for STI analysis, and blood for HIV and syphilis screening. A psychosocial and sexual questionnaire was completed. STI specimens were analysed for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infection. RESULTS: 200 MSM were recruited with a median age of 32 years (IQR 26-39.5). Their median number of sex partners within the last year was 5 (IQR 2-20). 155/200 (78%) reported only male sex partners while 45/200 (23%) reported sex with men and women. 77/200 (39%) reported transactional sex. At enrolment, 88/200 (44%) were HIV positive and 8/112 (7%) initially HIV-negative participants seroconverted during the study. Overall, 47/200 (24%) screened positive for either NG or CT. There were 32 MSM (16%) infected with NG and 7 (3.5%) of these men had NG infections at two anatomical sites (39 NG positive results in total). Likewise, there were 23 MSM (12%) infected with CT and all these men had infections at only one site. Eight of the 47 men (17%) were infected with both NG and CT. ASTI was more common than SSTI irrespective of anatomical site, 38 /200 (19%) versus 9/200 (5%) respectively (p<0.001). The anus was most commonly affected, followed by the oro-pharynx and then urethra. Asymptomatic infection was associated with transgender identity (OR 4.09 CI 1.60-5.62), ≥5 male sex partners in the last year (OR 2.50 CI 1.16-5.62) and transactional sex (OR 2.33 CI 1.13-4.79) but not with HIV infection. CONCLUSIONS: Asymptomatic STI was common and would not have been detected using a syndromic management approach. Although molecular screening for NG/CT is costly, in our study only four MSM needed to be screened to detect one case. This supports dual NG/CT molecular screening for MSM, which, in the case of confirmed NG infections, may trigger further culture-based investigations to determine gonococcal antimicrobial susceptibility in the current era of multi-drug resistant gonorrhoea