Qualitative assessment component mMom final evaluation report

Poor education, socio-economic and social status, as well as rural/remote residence are cited as primary determinants of poor health outcomes amongst ethnic minorities (EM) in Vietnam. The mMOM project implemented an innovative, integrated mobile health (mHealth) program to improve the maternal, newborn and child health (MNCH) of ethnic minority women (EMW). The project reached its target audience of EMW and women living in remote areas, engaging women in their MNCH care, with acceptance of the interventions across all stakeholder groups. The report reviews project aims and outcomes as well as avenues for scaling up

Exclusive Intermediation

In this paper, we argue that an important function fulfilled by intermediaries is to facilitate trust by enabling social pressure towards the enforcement of informal agreements. To that end, we develop a new model that uses network theory to show that intermediaries who have exclusivity over a large enough number of interaction opportunities are able to exploit their position in the chains of interactions in the market to overcome incentive problems that would otherwise shut down the market. We derive conditions on the network structure under which intermediaries fulfill this function. Finally, we analyze two applications: (1) the market for short termapartment rentals; and (2) a financial market with investors and entrepreneurs. We provide additional examples suggesting that this paper uncovers an important channel through which intermediaries operate

A framework for ensemble modelling of climate change impacts on lakes worldwide : the ISIMIP Lake Sector

Empirical evidence demonstrates that lakes and reservoirs are warming across the globe. Consequently, there is an increased need to project future changes in lake thermal structure and resulting changes in lake biogeochemistry in order to plan for the likely impacts. Previous studies of the impacts of climate change on lakes have often relied on a single model forced with limited scenario-driven projections of future climate for a relatively small number of lakes. As a result, our understanding of the effects of climate change on lakes is fragmentary, based on scattered studies using different data sources and modelling protocols, and mainly focused on individual lakes or lake regions. This has precluded identification of the main impacts of climate change on lakes at global and regional scales and has likely contributed to the lack of lake water quality considerations in policy-relevant documents, such as the Assessment Reports of the Intergovernmental Panel on Climate Change (IPCC). Here, we describe a simulation protocol developed by the Lake Sector of the Inter-Sectoral Impact Model Intercomparison Project (ISIMIP) for simulating climate change impacts on lakes using an ensemble of lake models and climate change scenarios for ISIMIP phases 2 and 3. The protocol prescribes lake simulations driven by climate forcing from gridded observations and different Earth system models under various representative greenhouse gas concentration pathways (RCPs), all consistently bias-corrected on a 0.5 degrees x 0.5 degrees global grid. In ISIMIP phase 2, 11 lake models were forced with these data to project the thermal structure of 62 well-studied lakes where data were available for calibration under historical conditions, and using uncalibrated models for 17 500 lakes defined for all global grid cells containing lakes. In ISIMIP phase 3, this approach was expanded to consider more lakes, more models, and more processes. The ISIMIP Lake Sector is the largest international effort to project future water temperature, thermal structure, and ice phenology of lakes at local and global scales and paves the way for future simulations of the impacts of climate change on water quality and biogeochemistry in lakes.Peer reviewe

Harms of criminalization of sex work : how end-demand legislation and immigration policy shape labour, health and rights among im/migrant and indoor sex workers in Canada

Background and objectives: Globally, sex workers experience labour rights abuses, disproportionate burdens of workplace violence, and restrictions on safer ways of working (i.e., collectively and in indoor venues) due to criminalization. These inequities are often exacerbated among im/migrant sex workers, who may additionally face precarious legal status, restrictive immigration policies and racialized policing. Despite implementation of “end-demand” legislation (legal models aimed at ending clients’ demand for sexual services) in dozens of countries, little empirical research has explored how end-demand laws impact sex workers’ labour conditions. This dissertation sought to explore how end-demand laws and prohibitive immigration policy impact labour conditions, health and rights among im/migrant and indoor sex workers in Vancouver. Methods: This dissertation drew on quantitative and qualitative data collected from AESHA (An Evaluation of Sex Workers’ Health Access), a community-based open prospective cohort of 900+ women sex workers across Vancouver, Canada, who complete bi-annual interviewer-administered questionnaires and voluntary sexual health testing. Mixed methods (explanatory and confounder bivariate and multivariable logistic regression analyses; interrupted time series; coding of semi-structured interview data) were used to elucidate the impacts of end-demand laws and resulting law enforcement practices on indoor and im/migrant sex workers’ labour environments. Results: This dissertation found that end-demand legislation in Canada failed to improve sex workers’ access to justice, restricted access to supportive third parties and safer indoor venues, heightened the vulnerability of sex work venues to violence, and limited access to occupational health resources (condoms, community-led services); with negative implications exacerbated among im/migrant sex workers. Conclusion: These findings extend limited existing research on the impacts of end-demand legislation, and demonstrate that end-demand criminalization reproduces the harms of full criminalization models. These results have important implications for legislative, policy, and law enforcement reforms towards enabling safe labour environments among im/migrant and indoor sex workers. This dissertation calls for the decriminalization of sex work; removal of prohibitions on im/migrant sex work; sensitivity and anti-stigma trainings among authorities; dedicated efforts to address systemic racism in sex work policing; promoting rights-based municipal occupational health standards; and increasing support for sex worker-led outreach; to promote sex workers’ labour and human rights.Graduate and Postdoctoral StudiesGraduat

Soft power and global health: the sustainable development goals (SDGs) era health agendas of the G7, G20 and BRICS

Background: In 2017, the G20 health ministers convened for the first time to discuss global health and issued a communiqué outlining their health priorities, as the BRICS and G7 have done for years. As these political clubs hold considerable political and economic influence, their respective global health agendas may influence both global health priorities and the priorities of other countries and actors. Methods: Given the rising salience of global health in global summitry, we analyzed the health ministerial communiqués issued by the BRICS, G7 and G20 after the SDGs were adopted in 2015. We compared the stated health priorities of the BRICS, G7 and G20 against one another and against the targets of SDG 3 on health, using a traffic light system to assess the quality of their commitments. Results: With regard to the SDG 3 targets, the BRICS, G7 and G20 priorities overlapped in their focus on emergency preparedness and universal health coverage, but diverged in areas of environmental pollution, mental health, and maternal and child health. Health issues with considerable associated burdens of disease, including substance use, road traffic injuries and sexual health, were missing from the agendas of all three political clubs. In terms of SDG 3 principles and ways of working, the BRICS, G7 and G20 varied in their emphasis on human rights, equity and engagement with non-state actors, but all expressed their explicit commitment to Agenda 2030. Conclusions: The leadership of BRICS, G7 and G20 on global health is welcome. However, their relatively narrow focus on the potential impact of ill-health primarily in relation to the economy and trade may not be sufficiently comprehensive to achieve the Agenda 2030 vision of promoting health equity and leaving no-one behind. Recommendations for the BRICS, G7 and G20 based on this analysis include: 1) expanding focus to the neglected SDG 3 health targets; 2) placing greater emphasis on upstream determinants of health; 3) greater commitment to equity and leaving no-one behind; 4) adopting explicit commitments to rights-based approaches; and 5) making commitments that are of higher quality and which include time-bound quantitative targets and clear accountability mechanisms.Graduate and Postdoctoral StudiesNon UBCReviewedGraduat

Structural determinants of HIV/STI prevalence, HIV/STI/SRH access, and condom use among immigrant sex workers globally

OBJECTIVE: Given stark health inequities among precarious and criminalized workers, we aimed to apply a structural determinants framework to systematically review evidence on HIV/STI prevalence, access to HIV/STI/SRH services, and condom use among im/migrant sex workers (ISWs) globally. METHODS: Systematic search of peer-reviewed English studies (2009–2019). Eligible studies reported HIV/STI, access to HIV/STI/SRH services, and/or condom use and/or lived experiences among ISWs. Quantitative and qualitative data were synthesized using a structural determinants framework. RESULTS: Of 425 studies screened, 29 studies from 15 countries were included. HIV prevalence ranged from 0.3%–13.6% and varied across settings, with highest prevalence among undocumented ISWs in a high-income country (Portugal). Precarious immigration status was a structural factor associated with poorer HIV/STI outcomes, whereas qualitative narratives showed ISWs’ lived experiences as strongly shaped by policing and stigma. Despite disparities, in some settings, HIV and STI prevalence were lower and odds of condom use with clients were higher among ISWs relative to non-im/migrant SWs. This review identified a paucity of research on SRH and male and gender-diverse ISWs. Across legislative settings, criminalization of SW and im/migrant status, policing, and migration-related marginalization were prominent structural barriers to ISWs’ HIV/STI/SRH access. CONCLUSION: This review identified important inequities and variation in HIV/STI prevalence among ISWs globally. Our findings highlight impacts of the intersections of migration and criminalization, and suggest a need to reform criminalized SW laws; address punitive policing and immigration enforcement; enable safer indoor work environments; and expand community-based interventions towards promoting HIV/STI/SRH access and health equity among ISWs

Structural determinants of HIV/STI prevalence, HIV/STI/sexual and reproductive health access, and condom use among immigrant sex workers globally.

ObjectiveGiven stark health inequities among precarious and criminalized workers, we aimed to apply a structural determinants framework to systematically review evidence on HIV/sexually transmitted infection (STI) prevalence, access to HIV/STI/SRH services, and condom use among im/migrant sex workers (ISWs) globally.MethodsSystematic search of peer-reviewed studies published in English (2009-2019). Eligible studies reported HIV/STI, access to HIV/STI/SRH services, and/or condom use outcomes and/or lived experiences among ISWs. Quantitative and qualitative data were synthesized using a structural determinants framework.ResultsOf 425 studies screened, 29 studies from 15 countries were included. HIV prevalence ranged from 0.3 to 13.6% and varied across settings, with highest prevalence among undocumented ISWs in a high-income country (Portugal). Precarious immigration status was a structural factor associated with poorer HIV/STI outcomes, whereas qualitative narratives showed ISWs' lived experiences as strongly shaped by policing and stigma. Despite disparities, in some settings, HIV and STI prevalence were lower and odds of condom use with clients were higher among ISWs relative to non-im/migrant sex workers. This review identified a paucity of research on SRH and male and gender-diverse ISWs. Across legislative settings, criminalization of SW and im/migrant status, policing, and migration-related marginalization were prominent structural barriers to ISWs' HIV/STI/SRH access.ConclusionThis review identified important inequities and variation in HIV/STI prevalence among ISWs globally. Our findings highlight impacts of the intersections of migration and criminalization, and suggest a need to reform criminalized sex work laws; address punitive policing and immigration enforcement; enable safer indoor work environments; and expand community-based interventions towards promoting HIV/STI/SRH access and health equity among ISWs