Looking to the East: Youth Identity in Berlin Through Sculpture Centered on Consumerism, and Music Following the Fall of the Berlin Wall

The Fall of the Berlin Wall was a major moment at the end of the Cold War. It saw the destruction of a communist structure and then directly followed by the dissolution of communist nations like the German Democratic Republic and the USSR. When the Wall fell down, the Germans began to unify but they had been separate for forty years and had developed separate cultures and identities. Most people saw the whole of Germany immediately being western following the Fall of the Wall. I will argue and demonstrate, however, that the youth of Berlin, both the former Easterners and Westerners, gravitated towards an Eastern identity and ushered in a movement of Eastern Nostalgia

Evaluating the impact of PMTCT of HIV in Malawi: an immunization clinic-based surveillance approach

Thesis (Dr.P.H.)--Boston UniversityBackground: Prevention of mother-to-child transmission of HIV (PMTCT) is an important component of HIV programs in generalized epidemics. Malawi has made significant progress in expanding access to PMTCT services, yet little information is available to assess the impact on transmission rates. Surveillance to assess transmission rates is particularly important given the recent adoption of the 'Option B+' strategy, offering all HIV-positive pregnant and breastfeeding women life-long antiretroviral therapy. This evaluation introduced a novel surveillance approach to assess rates of mother-to-child transmission and to gauge feasibility for implementation in Malawi. Methods: Estimates of the vertical transmission rate were derived by testing a population-based sample of infants presenting for their first immunization clinic visit in four districts. Fifty-three clinics were sampled randomly and all caregivers of infants < 3 months old attending the immunization clinic were invited to participate. Infant dried blood spot (DBS) samples were tested for HIV exposure with an antibody test to determine maternal seropositivity. Positive samples were tested for HIV antigen using DNA PCR to determine infant seropositivity and the vertical transmission rate. Caregivers were surveyed about maternal receipt of PMTCT services. Findings: Of the 5,068 DBS samples included in the analysis 764 were ELISA positive, indicating 15.1% (14.1-16.1 %) of mothers were HIV-infected and had passed HIV antibodies to their infant. Sixty-five of the 764 ELISA-positive samples tested positive with DNA PCR, indicating a vertical transmission rate of 8.5% (6.6-10.7%). Survey data indicated 64.8% ofHIV positive mothers and 46.9% ofHIV exposed infants received some form of antiretroviral prophylaxis. · Conclusions: The observed vertical transmission rate was substantially lower than earlier modeled analyses, suggesting that Malawi's PMTCT program has generated substantial benefits through averting perinatal HIV infection. However, challenges to implementation of PMTCT remain, particularly around low reported coverage of antiretroviral prophylaxis for both mothers and infants. The evaluation approach was successfully carried out by existing clinic staff and can likely be scaled up successfully to assess temporal changes in PMTCT effectiveness in Malawi as Option B+ is introduced

Taking Malawi's option B+ programme from a B+ to an A+

In The Lancet HIV, Beth A Tippett Barr and colleagues present national estimates of early mother-to-child transmission (MTCT) of HIV and factors associated with early MTCT from the National Evaluation of Malawi’s Prevention of MTCT Program (NEMAPP) for the period 2014–16. Among HIV-exposed infants aged 4–12 weeks, the MTCT rate was 3·7% (95% CI 2·3–6·0) and consistent across all four subnational regions. A somewhat lower prevalence was observed among infants aged 4–7 weeks than among those aged 8–12 weeks (2·9% vs 5·2%; p=0·07). As expected, the mother’s antiretroviral therapy (ART) status during pregnancy was strongly associated with MTCT prevalence: it was 2·3% (95% CI 1·3–4·0) among those who were on ART during pregnancy compared with 19·6% (14·3–26·3) among those who were not on ART (p<0·0001

Long-term Care for Older People in South Africa: The Enduring Legacies of Apartheid and HIV/AIDS

This paper sets out a general framework for analysing long-term care (LTC) systems for older people in different countries and then applies this framework to a specific national setting. The paper considers the extent to which South Africa's emerging LTC system conforms to broader patterns observed across low- and middle-income countries and how far it has been shaped by more local effects. It finds that patterns of demand for LTC vary across different racial categories. Despite having lower rates of ageing that the white population, Africans account for the majority of LTC demand. Residential services cater primarily for older whites and there is a widespread perception that LTC for Africans should be a family responsibility. Across the sector there is evidence of gaps in service availability, limited state oversight and uneven service quality. In 2016 this led to a high-profile political scandal which may prompt more effective state responses to this growing societal challenge

Ageing and Elderly Care in the Arab Region: Policy Challenges and Opportunities

Populations are expected to age rapidly in the Arab countries during the coming few decades. However, the current evidence base indicates that many countries in the region are not paying attention to this demographic phenomenon. This is a particular concern as longevity is often accompanied by many years of ill health and disability and most of the countries in the region continue to rely on the family as the primary source of elder care. While the family, and particularly women, are expected to provide increasing support for longer, they are faced by a set of socio-demographic changes that may hinder their ability to provide such care. This paper focuses on the ageing demographics in the Arab region and reflects on the multiple-roles for women by utilising quantitative analysis of international population and socio-economic indicators as well as reviewing the background literature and current ageing policies in the region. The paper then discusses possible strategies to address increasing long-term care needs through a social capital lens, where support to informal carers particularly women is emphasised.Populations are expected to age rapidly in the Arab countries during the coming few decades. However, the current evidence base indicates that many countries in the region are not paying attention to this demographic phenomenon. This is a particular concern as longevity is often accompanied by many years of ill health and disability and most of the countries in the region continue to rely on the family as the primary source of elder care. While the family, and particularly women, are expected to provide increasing support for longer, they are faced by a set of socio-demographic changes that may hinder their ability to provide such care. This paper focuses on the ageing demographics in the Arab region and reflects on the multiple-roles for women by utilising quantitative analysis of international population and socio-economic indicators as well as reviewing the background literature and current ageing policies in the region. The paper then discusses possible strategies to address increasing long-term care needs through a social capital lens, where support to informal carers particularly women is emphasised

Evaluating the impact of prevention of mother-to-child transmission of HIV in Malawi through immunization clinic-based surveillance.

BACKGROUND: Prevention of mother-to-child transmission of HIV (PMTCT) programs can greatly reduce the vertical transmission rate (VTR) of HIV, and Malawi is expanding PMTCT access by offering HIV-infected pregnant women life-long antiretroviral therapy (Option B+). There is currently no empirical data on the effectiveness of Malawian PMTCT programs. This study describes a surveillance approach to obtain population-based estimates of the VTR of infants <3 months of age in Malawi immediately after the adoption of Option B+. METHODS AND FINDINGS: A sample of caregivers and infants <3 months from 53 randomly chosen immunization clinics in 4 districts were enrolled. Infant dried blood spot (DBS) samples were tested for HIV exposure with an antibody test to determine maternal seropositivity. Positive samples were further tested using DNA PCR to determine infant infection status and VTR. Caregivers were surveyed about maternal receipt of PMTCT services. Of the 5,068 DBS samples, 764 were ELISA positive indicating 15.1% (14.1-16.1%) of mothers were HIV-infected and passed antibodies to their infant. Sixty-five of the ELISA-positive samples tested positive by DNA PCR, indicating a vertical transmission rate of 8.5% (6.6-10.7%). Survey data indicates 64.8% of HIV-infected mothers and 46.9% of HIV-exposed infants received some form of antiretroviral prophylaxis. Results do not include the entire breastfeeding period which extends to almost 2 years in Malawi. CONCLUSIONS: The observed VTR was lower than expected given earlier modeled estimates, suggesting that Malawi's PMTCT program has been successful at averting perinatal HIV transmission. Challenges to full implementation of PMTCT remain, particularly around low reported antiretroviral prophylaxis. This approach is a useful surveillance tool to assess changes in PMTCT effectiveness as Option B+ is scaled-up, and can be expanded to track programming effectiveness for young infants over time in Malawi and elsewhere

Self-Reported Participation in PMTCT Activities among HIV-infected Mothers.

1<p>Caregiver report prior to ELISA testing.</p