Cost and cost-effectiveness of voluntary medical male circumcision in street-connected youth: Findings from an education-based pilot intervention in Eldoret, Kenya

Background: Voluntary medical male circumcision (VMMC) is a critical component of HIV prevention. VMMC policies have achieved initial targets in adult men yet continue to fall short in reaching younger men and adolescents. Setting: We present the cost and scale-up implications of an education-based, VMMC intervention for adolescent street-connected males, for whom the street has become their home and/or source of livelihood. The intervention was piloted as part of the Engaging Street Youth in HIV Interventions Project in Eldoret, Kenya. Methods: We used a micro-costing approach to estimate the average cost of a VMMC intervention in 116 street-connected youth. Average cost was estimated per individual and per cohort by dividing total cost per intervention by number of clients accessing the intervention over a 30-day period. Total average costs included direct and support procedure costs, educational costs, and direct research costs. Cost-effectiveness was measured in cost per DALYs averted over a 5 and 10-year period. Results: The total cost of the intervention was $12,526 over the 30-day period, with an average cost per individual of$108. The direct VMMC procedure cost was approximately $9 per individual. Personnel costs contributed the greatest percentage to the total intervention cost (38.2$108 per individual, the intervention averted 60166 DALYs in 5years resulting in a cost per DALY averted of $267. Conclusion: The VMMC intervention was highly cost-effective in Kenya, despite the additional costs incurred to reach SCY. Further scale-up may be warranted to effectively apply this intervention in comparable populations

Dilemmas of Development and The Reconstruction of Fashion

Sustainable development by its nature appears elusive. It seems the more we try to capture and pin it down the more it moves away from us leading us into murkier waters and all manner of contradictions. No more is this felt than in the fashion industry where we are presented with a number of oppositions. The fashion cycle renders styles obsolete before they have worn out generating waste and over-consumptive practices. But it can also bring into the fore practices that have resonance to sustainable development in terms of their location, orientation and consideration for the environment. As studies emerge considering the detrimental environmental impacts of the manufacture and consumption of new clothes, second-hand clothes have become a focus for research endeavours considering how they can be reincorporated into the fashion system and have resonance to an ever ‘fashion’ hungry consumer. This chapter discusses methods for the processing of second-hand clothes into fashionable items and, by drawing on the wealth of ‘waste’ materials through reselling, restyling and remanufacturing, argues that ways of re-appropriating them into a more environmentally focused fashion industry is possible and necessary. It sets out as it hypothesis that the global fashion system has value in its transformative powers but that damaging and exploitative forces are still preventing it from being a force for good. This is due to the nature of the items being produced, the way they are manufactured and how they are ultimately consumed and disposed of

Can pictures have explicatures?

This paper considers the question of whether pictures can be understood to give rise to explicit meanings. In relevance-theoretic terms, this means asking whether pictures give rise to ‘explicatures’. The definition of the term ‘explicature’ seems to rule out this possibility except in cases where pictures include or are accompanied by material with coded meanings. The paper considers a range of non-verbal phenomena with coded meanings, including pictograms (Forceville 2011, Forceville et al 2014). It then considers whether the explicature-implicature distinction could be relevant to pictures without such elements. Some assumptions communicated by pictures seem to be more ‘explicature-like’ than others, so it is possible that the distinction will be useful. The question is not merely terminological as the discussion leads to a fuller understanding of ways in which pictures communicate

Development of Long and Short Forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV

Understanding resilience in relation to HIV-related outcomes may help address racial/ethnic disparities, however, significant gaps in its measurement preclude in-depth study. Thus, this research aims to develop and evaluate the psychometric properties of long and short forms of the Multilevel Resilience Resource Measure for African American/Black Adults Living with HIV. To develop the items, we conducted a mixed methods study (N = 48) and reviewed published resilience measures. We completed content validity index analyses to ensure the items reflected the resilience construct. Next, we conducted 20 cognitive interviews and a field survey (N = 400). The long and short forms demonstrated acceptable to excellent psychometric properties based on factorial validity, internal consistency and convergent validity and on measurement invariance (conducted for the short form only). These measures provide a comprehensive framework to examine resilience and HIV-related outcomes and can inform resilience-building interventions to reduce racial and ethnic health disparities

Just plain Wronga?: a multimodal critical analysis of online payday loan discourse

Payday loans constitute one of the most rapidly expanding and controversial forms of consumer lending today. Payday lending – the selling of high-interest, short-term credit – has thrived in the wake of the decline of the traditional high street banking system and the reluctance on the part of many mainstream credit services, following the 2007/8 Global Financial Crisis, to lend to low income earners. This study critically examines the website of the industry leader in the UK, Wonga, a payday lender which recently rebranded and relaunched itself (in 2015) after being embroiled in a series of financial scandals. Our analysis centres on the new Wonga website, the gateway to its financial services, and identifies three inter-related discursive strategies through which the lender, in the wake of its financial misconduct, seeks to present itself as a reputable financial service provider, namely by (1) constructing the empowered and responsible borrower, (2) de-stigmatising both its service provision and its prospective customers, the payday borrower, and (3) minimising the consequences and risks associated with payday borrowing. We argue that, collectively, these strategies constitute an artful response by Wonga to the changing legislative and socio-economic contexts in which it and other payday lenders are now required to operate, permitting it to continue marketing and selling its high-interest rate financial services

Enabling the classroom and the curriculum: higher education, literary studies and disability

In this article the tripartite model of disability is applied to the lived experience of twenty-first-century higher education. The tripartite model facilitates a complex understanding of disability that recognises assumptions and discrimination but not at the cost of valued identity. This being so, not only the normative positivisms and non-normative negativisms but also the non-normative positivisms of the classroom and the curriculum are explored. Inclusion is taken as the starting point and the argument progresses to a profound and innovational appreciation of disability. The problem addressed is that inclusion, as shown in The Biopolitics of Disability, constitutes little more than inclusion-ism until disability is recognised in the context of alternative lives and values that neither enforce nor reify normalcy. Informed by this understanding, the article adopts the disciplinary example of literary studies and refers to Brian Friel’s Molly Sweeney as a primary text. The conclusion is that, despite passive and active resistance, disability enters higher education in many ways, most of which are beneficial to students and educators alike

Shot at Dawn: Late Photography and the Anti-War Memorial

The military executions of World War One are the subject of Chloe Dewe Mathews’s 2014 photographic series Shot at Dawn. These events—in which hundreds of soldiers were court-martialled and executed for cowardice and desertion—remain controversial, without consensus or established collective narrative. This article charts historic negotiations with the subject but also considers more recent efforts to integrate these proceedings within memorial practice. World War One remembrance activities, whilst diverse, have often emphasised sacrifice, heroism and community. Correspondingly, participation and engagement were core values in the major British World War One centenary arts project, titled 14-18 NOW, from which Shot at Dawn was commissioned. Chloe Dewe Mathews’s contribution to the programme, however, presents a photographic aesthetic of resistance to the principles of inclusivity and remembrance elsewhere embraced by the project. As such, the work challenges the consensual politics of commemoration and—through the practices of late photography, land art and performance pilgrimage— substitutes trauma and forgetfulness for reconciliation and memory

Communication media and the dead:from the Stone Age to Facebook

This article argues as follows: (i) The presence of the dead within a society depends in part on available communication technologies, specifically speech, stone, sculpture, writing, printing, photography and phonography (including the mass media), and most recently the internet. (ii) Each communication technology affords possibilities for the dead to construct and legitimate particular social groups and institutions – from the oral construction of kinship, to the megalithic legitimation of the territorial rights of chiefdoms, to the written word’s construction of world religions and nations, to the photographic and phonographic construction of celebrity-based neo-tribalism, and to the digital reconstruction of family and friendship. (iii) Historically, concerns about the dead have on a number of occasions aided the development of new communication technologies – the causal connection between the two can go both ways. The argument is based primarily on critical synthesis of existing research literature