How can the stigma of public transport as the ‘poor man’s vehicle’ be overcome to enhance sustainability and climate change mitigation?

Natural Resources Forum, a United Nations Sustainable Development Journal is running a special series over the 2009-2011 period on themes to be considered by the United Nations Commission on Sustainable Development in its 18th and 19th sessions: chemicals, mining, sustainable consumption and production, transport and waste management. In this issue, experts address the question: “How can the stigma of public transport as the ‘poor man’s vehicle’ be overcome to enhance sustainability and climate change mitigation?

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

“How can the stigma of public transport as the ‘poor man's vehicle’ be overcome to enhance sustainability and climate change mitigation?”

This is Professor M. Sohail (Khan)'s contribution to this collaborative article, which was published in a special issue (transport) of the journal, Natural Resources Forum [© 2010 The Authors. Natural Resources Forum © 2010 United Nations]. The complete and definitive version is available at: http://dx.doi.org/10.1111/j.1477-8947.2010.01316.xNatural Resources Forum, a United Nations Sustainable Development Journal is running a special series over the 2009-2011 period on themes to be considered by the United Nations Commission on Sustainable Development in its 18th and 19th sessions: chemicals, mining, sustainable consumption and production, transport and waste management. In this issue, experts address the question: “How can the stigma of public transport as the ‘poor man’s vehicle’ be overcome to enhance sustainability and climate change mitigation?