Human immunodeficiency virus (HIV) infection in tuberculosis patients in Addis Ababa

BACKGROUND: In a country with a rapidly spreading HIV epidemic information regarding HIV and TB Co-infection are lacking. OBJECTIVES: To determine the prevalence of HIV infection in a representative sample of sputum-positive tuberculosis patients. METHODS: A cross-sectional survey whereby blood sample was collected from 236 consecutively coming smear positive pulmonary tuberculosis patients for HIV testing. This study, which involved all the health centres in Addis Ababa, was carried out during August 1, 1998 to the end of December 1998. RESULTS: Of the 236 blood samples collected, 107(45.3%) were HIV positive. Among the HIV positives, 66 (61.7%) were male and 41(38.3%) females. The HIV-TB co-infection was highest in the age group 20-49 and the largest number of TB co-infection (75% of all such co-infection) was found in the 20-39 age group. There was no significant difference between the HIV positive and negative TB patients concerning to other socio-demographic factors or presenting symptoms. CONCLUSION: The prevalence of co-infection appeared to have increased compared to previous studies, 6.6%, 20 & 25% and 44.4% in 1990, 1995, and 1996, respectively. This trend may have a serious impact on the control of tuberculosis. Co-ordinating strategies of the TB and HIV control programs is recommended. (Ethiopian Journal of Health Development, 2000, 14(3): 277-282

Entry points for enabling gender equality in agricultural and environmental innovation

Men and women on average report growing power and freedom to shape their lives as well as declining poverty in their villages across the 137 GENNOVATE village-level case studies. Wider forces in the macro environments as well as improvements in rural livelihoods due to agricultural innovation contribute importantly to these promising trends. Yet, beneath these broad patterns, the GENNOVATE data show strong differences in how men and women – and their communities – experience and benefit from innovation processes. The research communities experiencing more inclusive innovation processes and rapid poverty reduction offer valuable lessons on which agricultural research and development (R&D) can build

Local normative climate shaping agency and agricultural livelihoods in sub-Saharan Africa

We introduce the concept of local normative climate to improve understanding of community- level social processes that shape women’s and men’s sense of agency and capacities for taking important decisions, including in their agricultural livelihoods. The idea of normative climate is informed by feminist literature that addresses concerns for the contextual, fluid, and relational properties of gender norms. We apply normative climate to a qualitative examination of men’s and women’s assessments of decade-long changes in their decision-making capacity in two village case studies as well as comparatively with 24 village cases from seven sub-Saharan African countries. The case studies reveal how a normative climate is shaped by contextual influences that give rise to social processes where, for instance, changes in decision-making and agricultural opportunities may be perceived as empowering by only men in one village, and only by women in the other village. Comparative findings highlight how perceptions of agency are rooted in fluid normative expectations that evolve differently for women and men as they move through their life cycle and as local institutions and opportunities change

Local normative climate shaping agency and agricultural livelihoods in sub-Saharan Africa

We introduce the concept of local normative climate to improve understanding of community- level social processes that shape women’s and men’s sense of agency and capacities for taking important decisions, including in their agricultural livelihoods. The idea of normative climate is informed by feminist literature that addresses concerns for the contextual, fluid, and relational properties of gender norms. We apply normative climate to a qualitative examination of men’s and women’s assessments of decade-long changes in their decision-making capacity in two village case studies as well as comparatively with 24 village cases from seven sub-Saharan African countries. The case studies reveal how a normative climate is shaped by contextual influences that give rise to social processes where, for instance, changes in decision-making and agricultural opportunities may be perceived as empowering by only men in one village, and only by women in the other village. Comparative findings highlight how perceptions of agency are rooted in fluid normative expectations that evolve differently for women and men as they move through their life cycle and as local institutions and opportunities change

Gendered aspirations and occupations among rural youth, in agriculture and beyond: A cross-regional perspective

Based on 25 case studies from the global comparative study ‘GENNOVATE: Enabling gender equality in agricultural and environmental innovation’, this paper explores rural young women’s and men’s occupational aspirations and trajectories in India, Mali, Malawi, Morocco, Mexico, Nigeria, and the Philippines. We draw upon qualitative data from 50 sex-segregated focus groups with the youth to show that across the study’s regional contexts, young rural women and men predominantly aspire for formal blue and white-collar jobs. Yet, they experience an aspiration achievement gap, as the promise of their education for securing the formal employment they seek is unfulfilled, and they continue to farm in their family’s production. Whereas some young men aspired to engage in knowledge-intensive or ‘modern’ agriculture, young women did not express any such interest. Framing our analysis within a relational approach, we contend that various gender norms that discriminate against women in agriculture dissuade young women from aspiring for agriculture-related occupation. We discuss the gendered opportunity spaces of the study sites, the meanings these hold for allowing young women and men to achieve their aspirations and catalyze agricultural innovation, and implications for agricultural policies and research for development. Our findings show that youth and gender issues are inextricably intertwined and cannot be understood in isolation one from the other

Community-based cross-sectional survey of latent tuberculosis infection in Afar pastoralists, Ethiopia, using QuantiFERON-TB Gold In-Tube and tuberculin skin test

<p>Abstract</p> <p>Background</p> <p>There is little information concerning community-based prevalence of latent tuberculosis infection (LTBI) using T-cell based interferon-γ (IFN-γ) release assays (IGRAs), particularly in TB endemic settings. In this study, the prevalence of LTBI in the Afar pastoral community was assessed using QuantiFERON-TB Gold In-Tube (QFTGIT) and tuberculin skin tests (TST).</p> <p>Methods</p> <p>A community-based cross-sectional survey of LTBI involving 652 apparently healthy adult pastoralists was undertaken in the pastoral community of Amibara District of the Afar Region between April and June 2010.</p> <p>Results</p> <p>The prevalence of LTBI was estimated as 63.7% (363/570) using QFTGIT at the cut-off point recommended by the manufacturer (≥ 0.35 IU/ml IFN-γ), while it was 74.9% (427/570) using a cut-off point ≥ 0.1 IU/ml IFN-γ. The QFTGIT-based prevalence of LTBI was not significantly associated with the gender or age of the study participants. However, the prevalence of LTBI was 31.2% (183/587) using TST at a cut-off point ≥ 10 mm of skin indurations, and it was higher in males than females (36.8% vs. 23.5%, X²= 11.76; p < 0.001). There was poor agreement between the results of the tests (k = 0.098, 95% CI, 0.08 - 0.13). However, there was a positive trend between QFTGIT and TST positivity (X²= 96.76, P < 0.001). Furthermore, individuals with skin indurations ≥ 10 mm were 13.6 times more likely to have positive results using QFTGIT than individuals with skin indurations of 0 mm (adjusted OR = 13.6; 95%CI, 7.5 to 24.7, p < 0.001).</p> <p>Conclusions</p> <p>There is currently no agreed gold standard for diagnosis of LTBI. However, the higher prevalence of LTBI detected using QFTGIT rather than TST suggests that QFTGIT could be used for epidemiological studies concerning LTBI at the community level, even in a population unreactive to TST. Further studies of adults and children will be required to assess the effects of factors such as malnutrition, non-tuberculosis mycobacterial infections, HIV and parasitic infections on the performance of QFTGIT.</p

Immunologival Consequences of Mycobacterium tuberculosis and Human Immunodeficiency Virus coinfection in Ethiopia

Coinfections with Mycobacterium tuberculosis (MTB) during HIV-infection are a major problem in African countries because they lead to a higher death rate. In this thesis we investigated the interaction and the immunological consequences of HIV/TB coinfection. First we focussed on the burden of HIV-infection in TB patients and its impact on screening and diagnostic methods of MTB. (part I) We demonstrate a high rate of HIV-infection among suspected TB patients, although still a lot of coinfected cases might be missed due to lower sensitivity of the diagnostic tests, which increases the risk of transmission of TB in the community.To study the impact of HIV-infection on clinical read-outs of MTB infection further, we determined the in vivo tuberculin PPD skin test reactivity, positivity and conversion rate in adult HIV-infected and non-infected Ethiopians. We observed lower PPD skin test positivity rate among clinically diagnosed MTB-infected adults with and without HIV-infection in Ethiopia, which suggests the need for other sensitive methods to detect active TB cases, particularly among HIV positives. To study the immunological consequences of HIV-MTB coinfection, we examined immune activation parameters and disease progression. (part II) We analysed the expression of chemokine receptors CCR5 and CXCR4 on CD4+ T-cells and plasma chemokine levels among TB patients with HIV co-infection during the first 2 months of anti-TB treatment. We showed that increased expression of CCR5 and CXCR4 on activated CD4+ T-cell population coupled with persistently elevated chemokines may provide a suitable condition for continuous replication of HIV associated with TB co-infection. To investigate immune activation, proliferation rate of T cell subsets was analyzed among HIV/TB (n=21), HIV (n=23), TB (n=20) and Healthy controls (n=20). A seven, three and twofold-increased rate of proliferation was observed on CD4+ T cells in HIV-TB (13.7%), HIV (6.6%) and TB (3.7%) infected individuals, respectively compared to healthy controls (1.9%). This implies that coinfected individuals experience even more activation of their immune system. Interestingly, analyses of HIV-infected individuals who were followed before and after development of clinical active tuberculosis disease, showed a sustained/increased level of immune activation level paralleling the level of plasma viral RNA level and a progressive loss of CD4+ T cells. Thus, unlike in Caucasians, sustained level of immune activation in African HIV/TB coinfected patients despite anti-TB treatment will lead to the absence of immune restoration and reduction in plasma viral RNA level. Furthermore we analysed the level of regulatory T cells and found that these were increased in chronically ill HIV/TB patients. The level of Tregs correlated positively with HIV viral load and immune activation markers, thereby suggesting that these Tregs are antigen-dependent. Finally, we analysed disease progression and outcomes of HIV/TB coinfection. (part III) The slow CD4-decline in HIV-infected Ethiopians compared to their Caucasian counterparts was explained by lower immune activation levels in the Ethiopians. Survival rate analysis of HIV/TB coinfected individuals before and after implementation of antiretroviral therapy (ART) showed that although survival increased due to ART, however mortality is still higher in HIV-infected compared to HIV uninfected TB patients

Change in gender relations: managerial and transformative approaches of gender mainstreaming in agriculture

This paper explores the managerial and transformative approaches to gender mainstreaming in order to draw a more comprehensive understanding of how institutional and behavioural change processes occur with regard to gender equality. Drawing from the managerial and efficiency path, and planning tools used in implementing a project in Northern Nigeria, Promoting Sustainable Agriculture in Borno State or PROSAB, and by exploring largely unintended/unforeseen consequences of project actions, the paper argues that change in gender relations should be viewed not as outcome of technology transfer following a simple input-output model conceptualised largely in linear terms, but rather as a complex social phenomenon based on people’s interests, motivations, relationships, and innovative actions that are embedded in their historical and cultural situations. It suggests that the managerial and efficiency approaches are insufficient to encourage change in gender relations. Drawing from the case of PROSAB, the paper underlines the importance of a transformative approach that understands change processes in gender relations and success in women empowerment, which are influenced by the interplay of multiple factors that are not project controlled