Revisiting the understanding of "transactional sex" in sub-Saharan Africa: A review and synthesis of the literature.

In sub-Saharan Africa, young women ages 15-24 have more than twice the risk of acquiring HIV as their male counterparts. A growing body of epidemiological evidence suggests that the practice of "transactional sex" may contribute to this disparity. Over the last 15 years, the social sciences have contributed significantly to understanding the meaning of and motivations for this practice. The findings from these studies are rich, but varied, rendering lessons difficult to navigate for intervention and further research. We therefore contribute a historically-grounded, comprehensive literature review on the nature and motivations for women's participation in transactional sex in sub-Saharan Africa. Drawing from over 300 studies (through 2014), we distill three prominent paradigms observed in the literature that we review toward presenting a unified conceptualization of the practice. "Sex for basic needs," the first paradigm, positions women as victims in transactional sexual relationships, with implications for interventions that protect girls from exploitation. In contrast, the "sex for improved social status" paradigm positions women as sexual agents who engage in transactional sex toward attaining a middle-class status and lifestyle. Finally, a third paradigm, "sex and material expressions of love," draws attention to the connections between love and money, and the central role of men as providers in relationships. We find important commonalities in the structural factors that shape the three paradigms of transactional sex including gender inequality and processes of economic change. We suggest that there are three continua stretching across these paradigms: deprivation, agency, and instrumentality. This review proposes a definition of transactional sex and discusses implications for research and interventions aiming to reduce young women's risk of HIV through such relationships. We consider the consequences of drawing from too narrow an understanding of the practice, and highlight the benefits of a broader conceptualization

Двадцать лет и двадцать недостатков Конституции России

The subject of the research is the legal norms of the current Constitution of the Russian Federation. The work analyzes the chapters of Constitution, identifies the main shortcomings of the existing norms that do not correspond to modern reality and puts forward proposals for their change.The purpose of the study is to confirm or disprove the hypothesis that changes to the Constitution of the Russian Federation are inevitable due to the presence of defects in it that cannot be eliminated in any other way.The methodological basis of the research is a set of general scientific methods of knowledge and special scientific techniques and methods developed in law, including: logical method, comparative legal analysis, system method and formal legal analysis.The main results and scope of their application. The problems that critically affect the stable development of our society and state and its success were formulated. Among these problems are: the absence in the Constitution of the institute of parliamentary control over the executive authorities; the rise of the institution of the President of the Russian Federation over the three branches of government; the unequal status of constituent entities of the Russian Federation; the absence in the Constitution of the concepts "public property" or "national heritage". A significant part of these problems is related to the text of the current Constitution of the Russian Federation. In this regard, the author notes that the current Constitution of the Russian Federation has many defects. The author points out 20 drawbacks of the current Constitution of Russia which make the authorities imitate the principles of democracy and people's power in the actual political practice and substantiates the conclusion on the necessity of the constitutional reform.Conclusions. Revision of the Constitution of the Russian Federation is inevitable , since the Basic Law of the country is not devoid of shortcomings that require correction and legislative changes.Выделяются двадцать недостатков действующей Конституции РФ, которые провоцируют власть на имитацию принципов демократии и народовластия в реальной политической практике, и обосновывается вывод о необходимости конституционной реформы

Отчет о Профессорском форуме 2019 «Наука. Образование. Регионы» (Москва, 6–7 февраля 2019 г.)

The article presents the report on the professorial forum 2019 "Science. Education. Regions", held on February 6 and 7, 2019 in Moscow, Russia, on the initiative of the Russian Professorial Assembly and the Civic Chamber of the Russian Federation.Представлен отчет о Профессорском форуме 2019 «Наука. Образование. Регионы»,состоявшемся 6 и 7 февраля 2019 г. в Москве по инициативе Российского профессор‐ского собрания и Общественной палаты России

Management of patients with acute ST-segment elevation myocardial infarction in Russian hospitals adheres to international guidelines

Objective - Russia has one of the highest cardiovascular mortality rates. Modernisation of the Russian health system has been accompanied by a substantial increase in uptake of percutaneous coronary intervention (PCI), which substantially reduces the risk of mortality in patients with acute ST-elevation myocardial infarction (STEMI). This paper aims to describe contemporary Hospital treatment of acute STEMI among patients in a range of hospitals in the Russian Federation. Methods - This study used data from a prospective observational cohort of 1128 suspected patients with myocardial infarction recruited in both PCI and non-PCI hospitals across 13 regions and multiple levels of the health system in Russia. The primary objective was to examine the use of reperfusion strategies in patients with STEMI. Results - Among patients reaching PCI centres within 12 hours of symptom onset, the vast majority received angiography and PCI, regardless of age, sex and comorbidity, in line with current European Society of Cardiology guidelines. Conclusion- Patients reaching Russian hospitals are very likely to receive appropriate treatment, although performance varies. The best hospitals can serve as beacons of good practice as PCI facilities continue to expand across Russia where geography allows

Can the UNAIDS modes of transmission model be improved? A comparison of the original and revised model projections using data from a setting in west Africa.

OBJECTIVE: The UNAIDS modes of transmission model (MoT) is a user-friendly model, developed to predict the distribution of new HIV infections among different subgroups. The model has been used in 29 countries to guide interventions. However, there is the risk that the simplifications inherent in the MoT produce misleading findings. Using input data from Nigeria, we compare projections from the MoT with those from a revised model that incorporates additional heterogeneity. METHODS: We revised the MoT to explicitly incorporate brothel and street-based sex-work, transactional sex, and HIV-discordant couples. Both models were parameterized using behavioural and epidemiological data from Cross River State, Nigeria. Model projections were compared, and the robustness of the revised model projections to different model assumptions, was investigated. RESULTS: The original MoT predicts 21% of new infections occur in most-at-risk-populations (MARPs), compared with 45% (40-75%, 95% Crl) once additional heterogeneity and updated parameterization is incorporated. Discordant couples, a subgroup previously not explicitly modelled, are predicted to contribute a third of new HIV infections. In addition, the new findings suggest that women engaging in transactional sex may be an important but previously less recognized risk group, with 16% of infections occurring in this subgroup. CONCLUSION: The MoT is an accessible model that can inform intervention priorities. However, the current model may be potentially misleading, with our comparisons in Nigeria suggesting that the model lacks resolution, making it challenging for the user to correctly interpret the nature of the epidemic. Our findings highlight the need for a formal review of the MoT

The relation of gender role attitudes with depression and generalised anxiety disorder in two Russian cities

Background - Reported traditional gender role attitudes (GRAs) have been related to worse mental health in western countries. This study examined the link of GRAs with symptoms of depression and generalised anxiety disorder (GAD) in two Russian cities. Methods - We used interview data from the cross-sectional Know Your Heart Study conducted among 5099 adults aged 35-69 in the Russian cities of Arkhangelsk and Novosibirsk between 2015 and 2017. Attitudes about gender inequality and division of labour between women and men at home or in the public sphere were measured by single items. Binary variables indicating presence of symptoms of depression and GAD were defined by a cut-off of ≥ 5 of the PHQ-9 and GAD-7 scores respectively. Multivariable logistic regression was used to determine crude and adjusted associations. Results - There was evidence that all types of GRAs were associated with symptoms of depression and GAD consistent with a U-shape after controlling for confounding with stronger evidence for all relationships for depression than for GAD. Odds of depressive symptoms were elevated among participants strongly agreeing to gender inequality and gender division of labour. There was good evidence for effect measure modification by age. Limitations - The possibilities of measurement error of the exposure and outcomes, residual confounding and reverse causality are important limitations of this study. Conclusions - Agreeing to gender inequality and gender division of labour was associated with reporting symptoms of common mental disorders in Russia. This study adds evidence for a link of GRAs with mental health from a non-western context

Pre-hospital delays among patients with acute coronary syndrome in the Russian Federation: a multicentre prospective observational cohort study (the AMIR Study)

Objective: This study aimed to describe total pre-hospital delays (symptom onset to admission), patient delays (symptom onset to calling for help), and transport delays (calling for help to admission) experienced by patients with acute coronary syndrome (ACS) in Russia and identify factors associated with longer delays. Methods: A prospective observational cohort study of ACS patients with myocardial infarction recruited in hospitals providing percutaneous coronary intervention (PCI) and those that do not (non-PCI) in 13 regions and at multiple levels of the health system in Russia. Data were collected on pre-hospital delays between symptom onset and admission to the hospital providing definitive treatment, divided into patient delay (time between symptom onset and calling for help) and transport delay (time between calling for help and admission). Results: Of 902 patients, 701 (77.7%) had full data on pre-hospital delays. The median total pre-hospital delay in our study was 5.1 h, the median patient delay was 1.5 h, and the median transport delay was 2.1 h. Patient delays did not differ by age and sex, although having an ST-elevation myocardial infarction (STEMI) and certain symptom presentations, including severe pain, reduced delays. Transport delays were markedly reduced in those transported by emergency medical services (EMS) and taken directly to the hospital of definitive treatment (rather than to one closer but unable to offer PCI). Although transport delays were reduced in those using EMS, just half of the patients using EMS had a transport delay of <2 h (first medical contact to admission). Among all patients taken directly to the hospital by EMS, 70% were STEMI patients. Of these STEMI patients, 78% had a transport delay of 2 h or more. Among these patients, only 16.0% received thrombolysis in the ambulance. As expected, regional differences were apparent with all types of delay, with the greatest variation found in transport delays. Conclusion: Delays are currently longer than the European Society of Cardiology guidelines for STEMI patients and other severe cases. Reducing patient delays will reduce overall delays. Transport delays are inevitable in many regions of Russia, but better triage of patients, increased use of EMS, and early thrombolysis in EMS, particularly for STEMI patients facing excessive transport delays, will reduce delays and buy time before PCI

Alcohol and fatal life trajectories in Russia: understanding narrative accounts of premature male death in the family

Background: In the post-Soviet period, Russian working-age men have suffered unusually high mortality rates. Earlier quantitative work found that part of this is attributable to hazardous and harmful patterns of alcohol consumption, which increased in the period of transition at a time of massive social and economic disruption and uncertainty. However, there has been very little work done to document and understand in detail the downward life trajectories of individual men who died prematurely from alcohol-related conditions. Building on an earlier case-control study, this unique qualitative study investigates the perceived interplay between men's drinking careers, their employment and family history, health and eventual death.Methods: In-depth interviews were conducted with close relatives (most often the widow) of 19 men who died between 2003 and 2005 aged 25-54 years whose close relatives reported that alcohol contributed to their death. The study was conducted in a typical medium-sized Russian city. The relative's accounts were analysed using thematic content analysis.Results: The accounts describe how hazardous drinking both contributed to serious employment, family and health problems, and was simultaneously used as a coping mechanism to deal with life crises and a decline in social status. The interviews highlighted the importance of the workplace and employment status for shaping men's drinking patterns. Common themes emerged around a culture of drinking in the workplace, peer pressure from colleagues to drink, use of alcohol as remuneration, consuming non-beverage alcohols,Russian-specific drinking patterns, attitudes to treatment, and passive attitudes towards health and drinking.Conclusions: The study provides a unique insight into the personal decline that lies behind the extremely high working-age mortality due to heavy drinking in Russia, and highlights how health status and hazardous drinking are often closely intertwined with economic and social functioning. Descriptions of the development of drinking careers, hazardous drinking patterns and treatment experiences can be used to plan effective interventions relevant in the Russian context

Spatial-temporal coherence of different scale hydrological processes in the Lena River delta

The Lena River delta is one of the hydrologically entertaining objects. Hundreds channels and thousands lakes as well as thawing ice complex and permafrost active layer dynamic allow to investigate spatial-temporal coherence of different scale hydrological processes. During 15 years Russian-German scientific collaboration on hydrological, hydrochemical and hydrobiological studies have been operated on different water objects for cause-effect relation of large and specific micro processes indication. Transient liquid-frozen water phase change is significant not only for active layer runoff forming but also for hydrochemical and biological specific. Thus, maximum of DOC is in the overlaying soil layer than permafrost border [Bobrova et al., 2013]. It could be used for modeling of runoff forming and biological activity estimation. Measured temperature of lacustrine bottom sediment of one thermokarst lake on Samoylov Island shows maximal volume 3,7 °C on 1,75 cm beneath water-sediment border [Skorospekhova, 2015]. It is also can be interpreted as biological processes activity, for example, organic material destruction with additional heating. It could be observed more detail and can be used for modeling of a lake thermic regime. Hydrobiological specificity shows similarity of species in the channels and lakes, poorness of biodiversity, especially in big channel; only stagnant in summer season Bulkurskaya channel has more zooplankton species in four times than the main river channel [Nigamatzyanova et al., 2015]. Decline of water turbidity from the delta top to channel edges is about 5-8 times [Charkin et al., 2009]. Considerable turbidity increase is formed according to permafrost thawing and can reach 500 g l-1 including high concentration of carbon and biogenic elements. Thermokarst lake degradation [Morgenstern et al., 2011] plays also an important role for permafrost hydrology in the delta. Outflow from an ice complex forms a high local suspended supply in adjacent river branches and influences on biological processes consequently [Dubinenkov et al., 2015]. Underestimated effect of water and sediment discharge increase in the middle part of river branches had been marked [Fedorova et al., 2015]. Head flux of the large Lena River forms taliks under channels with more sophisticated affect in the shoreline zone of the Laptev Sea due to aquifer dynamic and mixing of fresh and salt water. Talik effect on hydrology and sedimentation (and suspended material transformation) in the central part of the delta is currently carried out according to geophysical and hydrogeological methods. First field measurements are planned to be done in April 2016 and results will be presented in the ICOP 2016. The studies have been done with support of RFBR grant 14-05-00787 and 15-35-50949, in the framework of Russian-German projects “ CarboPerm” and “Scientific station “Samoylov Island”. The project for both SPBU and DFG funding had also applied for field and scientific investigation as well. References Bobrova, O.; Fedorova, I.; Chetverova, A.; Runkle, B. and Potapova, T. Input of Dissolved Organic Carbon for Typical Lakes in Tundra Based on Field Data of the Expedition Lena–2012. In Proceedings of the 19th International Northern Research Basins Symposium and Workshop, Southcentral Alaska, USA – August 11–17, 2013, 2013. Charkin, A.N.; Dudarev, O.V.; Semiletov, I.P.; Fedorova, I.; Chetverova, A.A.; J., Vonk; Sanchez- Garcia, L.; Gustafsson, ö. and Andersson, P. edimentation in the System of the Delta Lena River - the South Western Part of Buor-Haya Gulf (the Laptev Sea). In The 16th International Symposium on Polar Sciences. Incheon, Korea. 2009, 2009. Dubinenkov, I.; Flerus, R.; Schmitt-Kopplin, P.; Kattner, G. and Koch, B.P. [2015]: Origin-specific molecular signatures of dissolved organic matter in the Lena Delta. Biogeochemistry, 123(1):1–14, doi:10.1007/s10533-014-0049-0. Fedorova, I.; Chetverova, A.; Bolshiyanov, D.; Makarov, A.; Boike, J.; Heim, B.; Morgenstern, A.; Overduin, P. P.; Wegner, C.; Kashina, V.; Eulenburg, A.; Dobrotina, E. and Sidorina, I. [2015]: Lena delta hydrology and geochemistry: long-term hydrological data and recent field observations. Biogeosciences, 12(2):345–363, doi:10.5194/bg-12-345-2015. Morgenstern, A.; Grosse, G.; Günther, F.; Fedorova, I. and Schirrmeister, L. [2011]: Spatial analyses of thermokarst lakes and basins in Yedoma landscapes of the Lena Delta. The Cryosphere, 5(4):849–867, doi:10.5194/tc-5-849-2011. Nigamatzyanova, G.; Frolova, L.; Chetverova, A. and Fedorova, I. Hydrobiological investigation of branches of the Lena River edge zone. In Uchenye Zapiski Kazanskogo Universiteta, Seriya Estestvennye Nauki. 2015. in Russian. Skorospekhova, T. Report of a spring campaign of the expedition “Lena 2015”. AARI’s library stock, 2015