Sex workers and the cost of safe sex - the compensating differential for condom use in Calcutta

The practice of safe sex by commercial sex workers is considered central to preventing the transmission of AIDS in developing countries. The authors estimate the compensating differential for condom use among sex workers in Calcutta, based on results from a survey conducted in 1993. If, as suggested by anecdotal evidence, this loss in income is large, it would indicate the existence of strong disincentives for practicing safe sex. To identify the relationship between condom use and the average price per sex act, they follow an instrumental variable approach, exploiting an intervention program focused on providing information about the AIDS virus and about safe sex practices. The program, instituted in 1992, was not systematically administered. Using this method, they found that sex workers who always use condoms face a loss of 79 percent in the average earnings per sex act.Gender and Health,Adolescent Health,Health Monitoring&Evaluation,Reproductive Health,HIV AIDS

Believing in oneself : can psychological training overcome the effects of social exclusion?

This paper examines whether psychological empowerment can mitigate mental constraints that impede efforts to overcome the effects of social exclusion. Using a randomized control trial, we study a training program specifically designed to reduce stigma and build self-efficacy among poor and marginalized sex workers in Kolkata, India. We find positive and significant impacts of the training on self-reported measures of efficacy, happiness and self-esteem in the treatment group, both relative to the control group as well as baseline measures. We also find higher effort towards improving future outcomes as measured by the participants’ savings choices and health-seeking behaviour, relative to the control group. These findings highlight the need to account for psychological factors in the design of antipoverty programmes

A Society Based Research to Assess Adherence of Antiretroviral Therapy

Access Adherence to Antiretroviral Therapy. A community-based antiretroviral (ART) drugs adherence study was conducted in Kolkata, India beginning in January and concluding in March 2011. This study was designed to explore the level of adherence as well as factors influencing adherence to ART by those who are receiving treatment through a public health care delivery system. This health care system is implemented through the National AIDS Control Program in the state of West Bengal, India. The research findings showed a high degree of non-adherence, between 48-52%, among the ART recipients. The analysis highlights a number of key factors negatively influencing adherence including long waiting time at the ART center, distance from residence to ART Centre, travel related expenditure, and fear of being identified as HIV + to family members and neighbors. Some positive influences were identified in the data as well. If a person is a member of a positive people network there is a greater chance for adherence as well as if an individual self-identifies as positive to others. However, no single factor, rather a combination of several factors, proved to be responsible for influencing ART adherence among recipients. &nbsp

Sex workers, stigma and self-image: evidence from Kolkata brothels

This paper studies the link between self-image and behavior among those who face stigma due to poverty and social exclusion. Using a randomized field experiment with sex workers in Kolkata (India), we examine whether a psychological intervention to mitigate adverse effects of internalized stigma can induce behavior change. We find significant improvements in participants’ self-image, their savings choices and health clinic visits. Administrative data confirm that these changes in savings and preventive health behavior persist fifteen and 21 months later respectively. Our findings highlight the potential of purely psychological interventions to improve life choices and outcomes of marginalized groups

Kidney function in tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis users: a systematic review and meta-analysis of published literature and a multi-country meta-analysis of individual participant data

BACKGROUND: Previous WHO guidance on tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis (PrEP) suggests measuring creatinine levels at PrEP initiation and regularly afterwards, which might represent barriers to PrEP implementation and uptake. We aimed to systematically review published literature on kidney toxicity among tenofovir disoproxil fumarate-based oral PrEP users and conducted an individual participant data meta-analysis (IPDMA) on kidney function among PrEP users in a global implementation project dataset. METHODS: In this systematic review and meta-analysis we searched PubMed up to June 30, 2021, for randomised controlled trials (RCTs) or cohort studies that reported on graded kidney-related adverse events among oral PrEP users (tenofovir disoproxil fumarate-based PrEP alone or in combination with emtricitabine or lamivudine). We extracted summary data and conducted meta-analyses with random-effects models to estimate relative risks of grade 1 and higher and grade 2 and higher kidney-related adverse events, measured by elevated serum creatinine or decline in estimated creatinine clearance or estimated glomerular filtration rate. The IPDMA included (largely unpublished) individual participant data from 17 PrEP implementation projects and two RCTs. Estimated baseline creatinine clearance and creatinine clearance change after initiation were described by age, gender, and comorbidities. We used random-effects regressions to estimate the risk in decline of creatinine clearance to less than 60 mL/min. FINDINGS: We identified 62 unique records and included 17 articles reporting on 11 RCTs with 13 523 participants in meta-analyses. PrEP use was associated with increased risk of grade 1 and higher kidney adverse events (pooled odds ratio [OR] 1·49, 95% CI 1·22-1·81; I2=25%) and grade 2 and higher events (OR 1·75, 0·68-4·49; I2=0%), although the grade 2 and higher association was not statistically significant and events were rare (13 out of 6764 in the intervention group vs six out of 6782 in the control group). The IPDMA included 18 676 individuals from 15 countries (1453 [7·8%] from RCTs) and 79 (0·42%) had a baseline estimated creatinine clearance of less than 60 mL/min (increasing proportions with increasing age). Longitudinal analyses included 14 368 PrEP users and 349 (2·43%) individuals had a decline to less than 60 mL/min creatinine clearance, with higher risks associated with increasing age and baseline creatinine clearance of 60·00-89·99 mL/min (adjusted hazard ratio [aHR] 8·49, 95% CI 6·44-11·20) and less than 60 mL/min (aHR 20·83, 12·83-33·82). INTERPRETATION: RCTs suggest that risks of kidney-related adverse events among tenofovir disoproxil fumarate-based oral PrEP users are increased but generally mild and small. Our global PrEP user analysis found varying risks by age and baseline creatinine clearance. Kidney function screening and monitoring might focus on older individuals, those with baseline creatinine clearance of less than 90 mL/min, and those with kidney-related comorbidities. Less frequent or optional screening among younger individuals without kidney-related comorbidities may reduce barriers to PrEP implementation and use. FUNDING: Unitaid, Bill & Melinda Gates Foundation, WHO

The health and environmental impact of coal mining in Chhattisgarh

"In spite of the fact that coal mining for coal-fired power generation is one the most hazardous and damaging industries such that governments of Austria, Belgium, Canada, Finland, France, New Zealand, Sweden, United Kingdom have pledged to phase out coal over the next decades, India, China, the United States and Russia continue to rely heavily on coal for the generation of electricity. India is one of the world’s major coal producers, ranking third after China and the United States. Several national and international studies have established that the process of coal extraction, particularly opencast mining, and electrical generation by coal-fired power plants release a range of gaseous and solid chemicals and heavy metals into the atmosphere as a by-product of this process. Every step in the generation of electricity by coal-fired thermal power plants – the mining of coal, transportation, washing and preparation at the power plant, combustion and the disposal of post-combustion wastes carry serious risks on the health of miners, plant workers and residents in the vicinity of mines and power plants. Existing power plants in India, with few exceptions, are highly polluting- particularly as standards are only set for Particulate Matter (PM) rather than for all related pollutants including Sulphur dioxide (SO2), Nitrogen oxides (NOx) or heavy metals such as mercury. The PM standards are also lax. This research therefore crucially investigates the nature and impact of pollutants in air, soil, stream sediment and water on communities living close to opencast mines and coal-fired power plants in Chhattisgarh.