Social Networks, HIV/AIDS and Risk Perceptions

Understanding the determinants of individuals’ perceptions of their risk of becoming infected with HIV and their perceptions of acceptable strategies of prevention is an essential step towards curtailing the spread of this disease. We focus in this paper on learning and decision-making about AIDS in the context of high uncertainty about the disease and appropriate behavioral responses, and we argue that social interaction is an important determinant of risk perceptions and the acceptability of behavioral change. Using longitudinal survey data from rural Kenya and Malawi, we test this hypothesis. We investigate whether social interactions—and especially the extent to which social network partners perceive themselves to be at risk –exert causal influences on respondents’ risk perceptions and on one approach to prevention, spousal communication about the threat of AIDS to the couple and their children. The study explicitly allows for the possibility that important characteristics, such as unobserved preferences or community characteristics, determine not only the outcomes of interest but also the size and composition of networks. The most important empirical result is that social networks have significant and substantial effects on risk perception and the adoption of new behaviors even after controlling for unobserved factors.health, AIDS, information, social networks, Africa

Feminists and neo-Malthusians: Past and present alliances

This article examines a century of interactions between American feminists and American social movements seeking to influence population trends. The historical analysis focuses on relations between feminists and neo-Malthusians and attempts to determine when they are likely to enter into alliances. The two movements are found to be neither natural allies nor natural enemies. Sturdy alliances arise when both movements agree on certain ideological premises, share a common demographic goal, and perceive mutual benefit in an alliance. The origin of the common ground alliance between American feminists and American neo-Malthusians that was so prominently displayed at the International Conference on Population and Development at Cairo is examined. Since the two movements currently are found to possess no clear common goals, to share no basic ideological beliefs, and to have entered a relationship of questionable mutual benefit, the alliance is considered to be fragile

The Social and the Sexual: Networks in Contemporary Demographic Research

The analysis of networks has become an important theme in contemporary demographic research in both developed and developing countries, including investigations of the determinants of fertility behaviors, the interaction between social network and social structures and population policies, the role of intergenerational networks in aging societies, and the relevance for sexual networks for the spread of HIV AIDS. This paper reviews the current research on networks across several domains in demographic research, and it discusses some of the specific challenges of network-based approaches with respect to data collection, analytic approaches and methodologies, interpretation of results, and micro-to-macro aggregation by drawing on research conducted as part of the Kenyan Diffusion and Ideational Change Project (KDICP), the Malawi Longitudinal Study of Families and Health (MLSFH) and the Likoma Network Study (LNS)

Cohort Profile: The Malawi Longitudinal Study of Families and Health (MLSFH)

The Malawi Longitudinal Study of Families and Health (MLSFH) is one of very few long-standing publicly-available longitudinal cohort studies in a sub-Saharan African (SSA) context. It provides a rare record of more than a decade of demographic, socioeconomic and health conditions in one of the world\u27s poorest countries. With data collection rounds in 1998, 2001, 2004, 2006, 2008, 2010 and 2012 for up to 4,000 individuals, the MLSFH permits researchers to investigate the multiple influences that contribute to HIV risks in sexual partnerships, the variety of ways that people manage risk within and outside of marriage, the possible effects of HIV prevention policies and programs, and the mechanisms through which poor rural individuals, families, households, and communities cope with the impacts of high morbidity and mortality that are often---but not always---related to HIV/AIDS. The MLSFH been used to document (i) the influence of social networks on HIV-related behaviors and perceptions, (ii) the HIV prevention strategies employed by individuals in rural high-HIV prevalence contexts, (iii) the relationship between life-course transitions and HIV infection risks, (iv) the acceptability of HIV testing and counseling (HTC) and the consequences of HTC on subsequent behaviors, and (v) the health and well-being across the life-course of individuals facing multiple challenges resulting from high disease burdens and widespread poverty

Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality

Background: Polymyxins including colistin are an important "last-line" treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKp). Increasing use of colistin has led to resistance to this cationic antimicrobial peptide. Methods: A cohort nested within the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRACKLE) was constructed of patients with infection, or colonization with CRKp isolates tested for colistin susceptibility during the study period of December, 2011 to October, 2014. Reference colistin resistance determination as performed by broth macrodilution was compared to results from clinical microbiology laboratories (Etest) and to polymyxin resistance testing. Each patient was included once, at the time of their first colistin-tested CRKp positive culture. Time to 30-day in-hospital all-cause mortality was evaluated by Kaplan-Meier curves and Cox proportional hazard modeling. Results: In 246 patients with CRKp, 13% possessed ColR CRKp. ColR was underestimated by Etest (very major error rate = 35%, major error rate = 0.4%). A variety of rep-PCR strain types were encountered in both the ColS and the ColR groups. Carbapenem resistance was mediated primarily by blaKPC-2 (46%) and blaKPC-3 (50%). ColR was associated with increased hazard for in-hospital mortality (aHR 3.48; 95% confidence interval, 1.73-6.57; P < .001). The plasmid-associated ColR genes, mcr-1 and mcr-2 were not detected in any of the ColR CRKp. Conclusions: In this cohort, 13% of patients with CRKp presented with ColR CRKp. The apparent polyclonal nature of the isolates suggests de novo emergence of ColR in this cohort as the primary factor driving ColR. Importantly, mortality was increased in patients with ColR isolates