HIV and Partner Violence: Implications for HIV Voluntary\ud Counseling and Testing Programs in Dar es Salaam, Tanzania

This study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending a VCT clinic in Dar es Salaam, Tanzania. Men and women both perceive HIV testing as a way to plan for the future but are motivated to undergo testing by a number of different individual, relationship, and environmental factors. The women in our study described more barriers to HIV testing than did men, and women who have communicated with their partners about VCT before seeking services are significantly more likely to share their HIV test results than those who have not talked with their partners. Findings from this study led to a number of recommendations that could reduce the barriers women face in getting tested for HIV and in disclosing their serostatus to their partners, as well as reduce levels of partner violence. These recommendations pertain to VCT services as well as to the wider community and policy environment

Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis.

BackgroundEconomic compensation interventions may help support higher voluntary medical male circumcision (VMMC) coverage in priority sub-Saharan African countries. To inform World Health Organization guidelines, we conducted a systematic review of economic compensation interventions to increase VMMC uptake.MethodsEconomic compensation interventions were defined as providing money or in-kind compensation, reimbursement for associated costs (e.g. travel, lost wages), or lottery entry. We searched five electronic databases and four scientific conferences for studies examining the impact of such interventions on VMMC uptake, HIV testing and safer-sex/risk-reduction counseling uptake within VMMC, community expectations about compensation, and potential coercion. We screened citations, extracted data, and assessed risk of bias in duplicate. We conducted random-effects meta-analysis. We also reviewed studies examining acceptability, values/preferences, costs, and feasibility.ResultsOf 2484 citations identified, five randomized controlled trials (RCTs) and three non-randomized controlled trials met our eligibility criteria. Studies took place in Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Meta-analysis of four RCTs showed significant impact of any economic compensation on VMMC uptake (relative risk: 5.23, 95% CI: 3.13 to 8.76). RCTs of food/transport vouchers and conditional cash transfers generally showed increases in VMMC uptake, but lotteries, subsidized VMMC, and receiving a gift appeared somewhat less effective. Three non-randomized trials showed mixed impact. Six additional studies suggested economic compensation interventions were generally acceptable, valued for addressing key barriers, and motivating to men. However, some participants felt they were insufficiently motivating or necessary; one study suggested they might raise community suspicions. One study from South Africa found a program cost of US$91 per additional circumcision and US$450-$1350 per HIV infection averted.ConclusionsEconomic compensation interventions, particularly transport/food vouchers, positively impacted VMMC uptake among adult men and were generally acceptable to potential clients. Carefully selected economic interventions may be a useful targeted strategy to enhance VMMC coverage

Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review.

BackgroundVoluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify.MethodsWe systematically reviewed the literature to evaluate the impact of service delivery interventions (e.g., facility layout, service co-location, mobile outreach) on VMMC uptake among adolescent and adult men. For the main effectiveness review, we searched for publications or conference abstracts that measured VMMC uptake or uptake of HIV testing or risk reduction counselling within VMMC services. We synthesized data by coding categories and outcomes. We also reviewed studies assessing acceptability, values/preferences, costs, and feasibility.ResultsFour randomized controlled trials and five observational studies were included in the effectiveness review. Studies took place in South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. They assessed a range of service delivery innovations, including community-, school-, and facility-based interventions. Overall, interventions increased VMMC uptake; some successfully improved uptake among age-specific subpopulations, but urban-rural stratification showed no clear trends. Interventions that increased adult men's uptake included mobile services (compared to static facilities), home-based testing with active referral follow-up, and facility-based HIV testing with enhanced comprehensive sexual education. Six acceptability studies suggested interventions were generally perceived to help men choose to get circumcised. Eleven cost studies suggested interventions create economies-of-scale and efficiencies. Three studies suggested such interventions were feasible, improving facility preparedness, service quality and quantity, and efficiencies.ConclusionsInnovative changes in male-centered VMMC services can improve adult men's and adolescent boys' VMMC uptake. Limited evidence on interventions that enhance access and acceptability show promising results, but evidence gaps persist due to inconsistent intervention definition and delivery, due in part to contextual relevance and limited age disaggregation

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions.

Peer reviewedPublisher PD

A water-budget approach to restoring a sedge fen affected by diking and ditching

A vast, ground-water-supported sedge fen in the Upper Peninsula of Michigan, USA was ditched in the early 1900 s in a failed attempt to promote agriculture. Dikes were later constructed to impound seasonal sheet surface flows for waterfowl management. The US Fish and Wildlife Service, which now manages the wetland as part of Seney National Wildlife Refuge, sought to redirect water flows from impounded C-3 Pool to reduce erosion in downstream Walsh Ditch, reduce ground-water losses into the ditch, and restore sheet flows of surface water to the peatland. A water budget was developed for C-3 Pool, which serves as the central receiving and distribution body for water in the affected wetland. Surface-water inflows and outflows were measured in associated ditches and natural creeks, ground-water flows were estimated using a network of wells and piezometers, and precipitation and evaporation/evapotranspiration components were estimated using local meteorological data. Water budgets for the 1999 springtime peak flow period and the 1999 water year were used to estimate required releases of water from C-3 Pool via outlets other than Walsh Ditch and to guide other restoration activities. Refuge managers subsequently used these results to guide restoration efforts, including construction of earthen dams in Walsh Ditch upslope from the pool to stop surface flow, installation of new water-control structures to redirect surface water to sheet flow and natural creek channels, planning seasonal releases from C-3 Pool to avoid erosion in natural channels, stopping flow in downslope Walsh Ditch to reduce erosion, and using constructed earthen dams and natural beaver dams to flood the ditch channel below C-3 Pool. Interactions between ground water and surface water are critical for maintaining ecosystem processes in many wetlands, and management actions directed at restoring either ground- or surface-water flow patterns often affect both of these components of the water budget. This approach could thus prove useful in guiding restoration efforts in many hydrologically altered and managed wetlands worldwide.SUNY BrockportEnvironmental Science and Ecology Faculty Publication

A water-budget approach to restoring a sedge fen affected by diking and ditching

A vast, ground-water-supported sedge fen in the Upper Peninsula of Michigan, USA was ditched in the early 1900 s in a failed attempt to promote agriculture. Dikes were later constructed to impound seasonal sheet surface flows for waterfowl management. The US Fish and Wildlife Service, which now manages the wetland as part of Seney National Wildlife Refuge, sought to redirect water flows from impounded C-3 Pool to reduce erosion in downstream Walsh Ditch, reduce ground-water losses into the ditch, and restore sheet flows of surface water to the peatland. A water budget was developed for C-3 Pool, which serves as the central receiving and distribution body for water in the affected wetland. Surface-water inflows and outflows were measured in associated ditches and natural creeks, ground-water flows were estimated using a network of wells and piezometers, and precipitation and evaporation/evapotranspiration components were estimated using local meteorological data. Water budgets for the 1999 springtime peak flow period and the 1999 water year were used to estimate required releases of water from C-3 Pool via outlets other than Walsh Ditch and to guide other restoration activities. Refuge managers subsequently used these results to guide restoration efforts, including construction of earthen dams in Walsh Ditch upslope from the pool to stop surface flow, installation of new water-control structures to redirect surface water to sheet flow and natural creek channels, planning seasonal releases from C-3 Pool to avoid erosion in natural channels, stopping flow in downslope Walsh Ditch to reduce erosion, and using constructed earthen dams and natural beaver dams to flood the ditch channel below C-3 Pool. Interactions between ground water and surface water are critical for maintaining ecosystem processes in many wetlands, and management actions directed at restoring either ground- or surface-water flow patterns often affect both of these components of the water budget. This approach could thus prove useful in guiding restoration efforts in many hydrologically altered and managed wetlands worldwide

Child Welfare, Domestic Violence And Substance Abuse: A Report on Protocols and Practices Preliminary Report

The purpose of the Project is to examine issues related to child abuse/neglect and substance abuse and domestic violence and substance abuse. In particular, the Project is interested in determining how the child welfare system and domestic violence programs interact with substance abuse services

Child Welfare, Domestic Violence and Substance Abuse: A Review of the Literature, Promising Practices and Strategies

The purpose of this second and final report by the Project is to provide a synopsis of trends, promising practices and programs from across the nation and in Maine related to child abuse/neglect, domestic violence and substance abuse. The report illustrates that Maine is not alone in grappling with these problems. The report is intended, however, to offer several examples of what has been tried and what has been learned by other states and professionals over the past several years. A special emphasis has been placed on services and strategies that have utilized collaborative models of training and program development/delivery

Suicidal ideation and HIV risk behaviors among a cohort of injecting drug users in New Delhi, India

BACKGROUND: Data on mental health among injecting drug users in South Asia is scarce yet poor mental health among users has significant implications for the success of HIV prevention and treatment programmes. A cohort of 449 injecting drug users in Delhi was examined on the following issues (1) examine trends in suicidal ideation, suicide plan and suicidal attempts over a 12-month period, (2) examine association between injecting practices (receive and give used syringes) and suicidal ideation over a 12 month study period. METHODS: An observational study was conducted providing phased interventions with follow up interviews every 3 months to 449 injecting drug users (IDUs), from August 2004 to November 2005. The study was conducted in Yamuna Bazaar, a known hub of drug peddling in Delhi. Interventions included nutrition, basic medical services, needle exchange, health education, HIV voluntary counseling and testing, STI diagnosis and treatment, oral buprenorphine substitution, and detoxification, each introduced sequentially. RESULTS: Suicidal ideation and suicide attempts, did not significantly change over 12 months of observation, while suicide plans actually increased over the time period. Keeping other factors constant, IDUs with suicidal ideation reported more giving and receiving of used syringes in the recent past. Conclusions: Mental health services are warranted within harm reduction programmes. Special attention must be paid to suicidal IDUs given their higher risk behaviours for acquiring HIV and other blood borne infections. IDU intervention programmes should assess and address suicide risk through brief screening and enhanced counseling