The overlooked epidemic: Addressing HIV prevention and treatment among men who have sex with men in sub-Saharan Africa

Globally, less than 1 out of 20 men who have sex with men (MSM) has access to HIV prevention and care. UNAIDS has estimated that at least 5 to 10 percent of all HIV infections globally occur through male-to-male sexual activity. In spite of the high risk of HIV infection and evidence of extensive sexual networks, national HIV programs in Africa have been slow to address MSM in prevention and treatment efforts. To address these issues, the Population Council and the National AIDS Control Council of Kenya convened a meeting on May 14–15, 2008. The goals of the meeting were to justify and legitimize discussion of MSM at the national and regional levels and to build support for prevention, testing, and treatment services for MSM. The meeting brought together more than 60 representatives from national HIV programs, research organizations, bilateral donor agencies, multilateral programs, and MSM advocacy groups from 16 African countries. This consultation report summarizes the key findings and lessons learned that emerged at the meeting and outlines future priorities identified by participants

Heroin Treatment - New Alternative : proceedings of a seminar held on 1 November 1991, Ian Wark Theatre, Backer House, Canberra

The meeting today grows out of a study conducted jointly by the National Centre for Epidemiology and Population Health and the Australian Institute of Criminology in the early part of this year. That study was prompted by an invitation from the Chairman of the ACT Legislative Assembly’s Select Committee on HIV, Illegal Drugs and Prostitution - Mr Michael Moore - who invited us to examine the feasibility of a trial of the controlled availability of opioids in the ACT. Dr Gabriele Bammer, who directed that investigation, will be setting the scene for us by describing its conclusions at the outset of the day’s discussions. We hope that from that baseline we can move forward in the course of the day to explore the implications of those conclusions and to discuss whether or not it is appropriate to extend the feasibility study to the next stage. So our objective today is to explore the medical, health, social and law enforcement implications of evaluating, in the ACT, new approaches to the treatment of heroin dependent individuals. Drug policy is a highly political issue, any action to change the way we manage drug dependent people in the ACT has political implications for the ACT and for other parts of Australia as well. So I am delighted that we have representatives from drug and law enforcement agencies from most states of Australia here today and that many of the people who will frame attitudes to the proposed ACT trial will have an opportunity to discuss these issues in an open and uninhibited way.The meeting has been assisted by a grant from the ACT Government

Reproductive and sexual health in the Maldives: analysis of data from two cross-sectional surveys

<p>Abstract</p> <p>Background</p> <p>The Maldives faces challenges in the provision of health services to its population scattered across many small islands. The government commissioned two separate reproductive health surveys, in 1999 and 2004, to inform their efforts to improve reproductive and sexual health services.</p> <p>Methods</p> <p>A stratified random sample of islands provided the study base for a cluster survey in 1999 and a follow-up of the same clusters in 2004. In 1999 the household survey enquired about relevant knowledge, attitudes and practices and views and experience of available reproductive health services, with a focus on women aged 15-49 years. The 2004 household survey included some of the same questions as in 1999, and also sought views of men aged 15-64 years. A separate survey about sexual and reproductive health covered 1141 unmarried youth aged 15-24 years.</p> <p>Results</p> <p>There were 4087 household respondents in 1999 and 4102 in 2004. The contraceptive prevalence rate (CPR) for modern methods was 33% in 1999 and 34% in 2004. Antenatal care improved: more women in 2004 than in 1999 had at least four antenatal care visits (90.0% v 65.1%) and took iron supplements (86.7% v 49.6%) during their last pregnancy. The response rate for the youth survey was only 42% (varying from 100% in some islands to 12% in sites in the capital). The youth respondents had some knowledge gaps (one third did not know if people with HIV could look healthy and less than half thought condoms could protect against HIV), and some unhelpful attitudes about gender and reproductive health.</p> <p>Conclusions</p> <p>The two household surveys were commissioned as separate entities, with different priorities and data capture methods, rather than being undertaken as a specific research study. The direct comparisons we could make indicated an unchanged CPR and improvements in antenatal care, with the Maldives ahead of the South Asia region for antenatal care. The low response rate in the youth survey limited interpretation of the findings. But the survey highlighted areas requiring attention. Surveys not undertaken primarily for research purposes have important limitations but can provide useful information.</p

Getting men involved in family planning: Experiences from an innovative program

This study was designed to determine the effect of interventions on accelerated proactive male involvement in family planning (FP) and factors influencing acceptance of male contraceptive methods. It was observed that a program can be successful if management cadres can be motivated and involved in the process. Other findings suggest the importance of education and communication materials, supply of information, orientation of fieldworkers, and mobilization of resources including hands-on refresher training. Misconceptions about male contraception (particularly vasectomy) are rampant in traditional Bangladeshi society, thus ideas should be positively expressed through visual aids. Among the various communications materials, at least one must be for service providers. According to this report, motivation is important in getting men involved in FP, as are efforts to create a male-friendly service delivery system at existing service delivery centers. Specially scheduled hours should be set aside for the provision of information and services to men, from the Health and Family Welfare Centers and at the community level

Assessing wellbeing at school entry using the strengths and difficulties questionnaire: professional perspectives

&lt;p&gt;Background: Emotional and behavioural disorders in early childhood are related to poorer academic attainment and school engagement, and difficulties already evident at the point of starting school can affect a child’s later social and academic development. Successful transfer from pre-school settings to primary education is helped by communication between pre-school staff and primary school teachers. Typically, in Scotland, pre-school establishments prepare individual profiles of children before they start school around the age of five years, highlighting their strengths and development needs, for transfer to primary schools. There is, however, no consistent approach to the identification of potential social, emotional and behavioural problems. In 2010, in one local authority area in Scotland, the Strengths and Difficulties Questionnaire (SDQ) was introduced for children about to start school as a routine, structured, component of the transition process to help teachers plan support arrangements for classes and individual children. The SDQ assesses emotional, conduct, hyperactivity/ inattention and peer-relationship problems as well as pro-social behaviour. In order to be an effective means of communicating social and emotional functioning, the use of instruments such as the SDQ needs to be practicable. Finding out the views of pre-school education staff with experience of assessing children using the SDQ was, therefore, essential to establish its future utility.&lt;/p&gt; &lt;p&gt;Aim: The purpose of this study was to explore the views of pre-school education staff about assessing social and emotional wellbeing of children at school entry using the SDQ. The objectives were to examine the opinions of pre-school workers about completing the SDQ and to elicit their thoughts on the value of doing this and their perceptions of the usefulness of the information collected.&lt;/p&gt; &lt;p&gt;Method: Pre-school establishments were approached using a purposive sampling strategy in order to achieve a mix of local authority (n=14) and ‘partnership’ establishments (n=8) as well as different socio-economic areas. Semi-structured interviews (n=25) were conducted with pre-school head teachers (n=14) and child development officers (n=11) in order to explore the process of completing the SDQ along with perceptions of its value. The interviews were transcribed verbatim and analysed thematically.&lt;/p&gt; &lt;p&gt;Results: In general, staff in pre-school establishments viewed the use of the SDQ positively. It was seen as a chance to highlight the social and emotional development of children rather than just their academic or educational ability. Most felt that the SDQ had not identified anything they did not already know about a child. A minority, nevertheless, suggested that a previously unrecognised potential difficulty was brought to light, most commonly emotional problems. Completing the SDQ was felt to be relatively straightforward even though the staff felt under pressure from competing priorities. Concerns were, however, raised about the potential of labelling a child at an early stage of formal education.&lt;/p&gt; &lt;p&gt;Conclusion: The findings from this small scale study suggest that, from the point of view of pre-school education staff, it is feasible to assess children systematically for social and behavioural problems as part of the routine transition process at school entry.&lt;/p&gt

Silicone use in Nepali transgender women: The hazards of beauty

Purpose: It is widely believed that transgender individuals in Nepal inject silicone for face and body manipulation, a phenomenon thought to be common among transgender individuals globally. Therefore, this qualitative study conducted in Nepal explored: a) awareness of silicone use and sources of information; b) reasons for using silicone; c) notion of cost and quality of these procedures; d) reported negative aspects, including side effects; and, e) health seeking behaviours of Nepali transgender women. Design/methodology/approach: We carried out eight focus group discussions (FGDs) with transgender women at four different districts of Nepal, five in the capital Kathmandu and three in different rural areas. We also interviewed three transgender women who preferred not to participate in the FGD but were happy to be interviewed separately. Similarly, six interviews with stakeholders working for sexual and gender minority populations were also conducted. Findings: Most FGD participants were young (mean age 23.06±3.9 years) and the majority (55%; n=34) completed grade six to high school level. Peer networks of transgender people and the internet were the more popular sources of information about silicone. The decision to use silicone was largely influenced by the desire to look beautiful and more feminine. Often they appear not to follow the recommended procedures for silicone use. Their health seeking behaviour regarding side effects or complications of these procedures was very poor. Originality/value: Findings reflect that targeted interventions aimed at transgender individuals should educate them on the use of silicone, as well as explore safe and affordable approaches to meet gender-related appearance needs of Nepali transgender people

Binge drinking: a serious, under-recognized problem among women and girls

Binge drinking is a dangerous behavior but is not widely recognized as a women's health problem. Drinking too much --including binge drinking-- results in about 23,000 deaths in women and girls each year. Binge drinking increases the chances of breast cancer, heart disease, sexually transmitted diseases, unintended pregnancy, and many other health problems. Drinking during pregnancy can lead to sudden infant death syndrome and fetal alcohol spectrum disorders. About 1 in 8 women aged 18 years and older and 1 in 5 high school girls binge drink. Women who binge drink do so frequently --about 3 times a month-- and have about 6 drinks per binge. There are effective actions communities can take to prevent binge drinking among women and girls.Fact sheet released by the Centers for Disease Control and Prevention's Office of Surveillance, Epidemiology and Laboratory Services (OSELS) in association with: Vital signs: Binge drinking among women and high school girls--United States, 2011, published: MMWR. Morbidity and mortality weekly report ; v. 62, early release, January 8, 2013, p. 1-5."CS236885-B.""January 2013.""Publication date: 01/08/2012 [i.e., 2013]."Title from title screen (viewed January 8, 2013).Introduction -- Problem -- Who's at risk? -- What can be done -- Science behind this issue -- Related links -- Social media -- Read associated MMWRMode of access: World Wide WebText document (PDF)

Prevention Research Centers Program: researcher-community partnerships for high-impact results

The Prevention Research Centers (PRC) Program, administered and funded by the Centers for Disease Control and Prevention (CDC), is a network of academic, community, and diverse public health partners that conducts research aimed at reducing the leading causes of death and disability. The researchers are based at schools of medicine and public health across the country; in 2011, 37 academic centers were funded. Each PRC focuses on an area of expertise (e.g., controlling obesity, preventing cancer, or enabling healthy aging). The centers analyze the effectiveness of public health policies, and produce interventions, training programs, dissemination approaches, and other strategies that align with national and global initiatives to improve public health (Ammerman, Harris, Brownson, Tovar-Aguilar, & PRC Steering Committee, 2011). Each PRC's research is tailored to specific communities comprising largely underserved populations, such as Hispanics, older Americans, or rural residents, for whom the burden of chronic disease is greater than for the United States as a whole. The PRCs partner with members of the community that their research is intended to benefit; these partnerships give a voice to vulnerable populations not often heard in prevention research. Community members help choose research topics and assist in the research process, ensuring that real- world conditions are taken into consideration and thereby improving the contextual quality of the research. These collaborations increase the likelihood that successful research results will be appropriate for and used by the community. Other partners, including community-based organizations, health care systems, health advocacy groups, local and state health departments, and the business community, help in disseminating research results and effective programs by facilitating changes in policies, systems, and environments. These partnerships enable the results of the community research to spread well beyond the original study population. The PRC model is useful in targeting not only chronic disease but other public health problems as well, including immunization, infectious diseases such as HIV and sexually transmitted diseases, unintentional injury, and environmental health risks.Diane Hawkins-Cox, Jeffrey R. Harris, Ross C. Brownson, Alice Ammerman, Barbara Sajor GrayExcerpted from Thomas P. Gullotta & Martin Bloom (Editors). Encyclopedia of Primary Prevention and Health Promotion. 2nd ed. New York: Springer Science+Business Media, in press. Preprinted with permission."CS231390."Includes bibliographical references (p. 16-19)

Essential health information available for India in the public domain on the internet

<p>Abstract</p> <p>Background</p> <p>Health information and statistics are important for planning, monitoring and improvement of the health of populations. However, the availability of health information in developing countries is often inadequate. This paper reviews the essential health information available readily in the public domain on the internet for India in order to broadly assess its adequacy and inform further development.</p> <p>Methods</p> <p>The essential sources of health-related information for India were reviewed. An extensive search of relevant websites and the PubMed literature database was conducted to identify the sources. For each essential source the periodicity of the data collection, the information it generates, the geographical level at which information is reported, and its availability in the public domain on the internet were assessed.</p> <p>Results</p> <p>The available information related to non-communicable diseases and injuries was poor. This is a significant gap as India is undergoing an epidemiological transition with these diseases/conditions accounting for a major proportion of disease burden. Information on infrastructure and human resources was primarily available for the public health sector, with almost none for the private sector which provides a large proportion of the health services in India. Majority of the information was available at the state level with almost negligible at the district level, which is a limitation for the practical implementation of health programmes at the district level under the proposed decentralisation of health services in India.</p> <p>Conclusion</p> <p>This broad review of the essential health information readily available in the public domain on the internet for India highlights that the significant gaps related to non-communicable diseases and injuries, private health sector and district level information need to be addressed to further develop an effective health information system in India.</p