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Cover -- Half Title -- Title -- Copyright -- Contents -- List of Tables -- List of Figures -- Preface -- Editors' Overview -- PART ONE ISSUES IN INTEGRATION OF COMMUNITY-BASED DISTRIBUTION PROGRAMS -- 1 The Nature of Community- Based Distribution: Some Field Results and Problems -- 2 Issues in Integrated Family Planning and Health Programs -- 3 The Danfa, Lampang and Narangwal Projects: A Comparative Review -- 4 Selection of Family Planning and Health Interventions for Community-Based Distribution Projects -- PART TWO CONTRACEPTIVE SERVICES IN CBD PROGRAMS -- 5 Family Planning Components in Community-Based Distribution Projects: Risk/Benefit Considerations in the Choice of Methods -- 6 Family Planning and Health in Rural Bangladesh -- PART THREE ADAPTING ORAL REHYDRATION THERAPY TO CBD PROGRAMS -- 7 Oral Rehydration for the Treatment of Diarrhea: Its Value as a Health Component in Community-Based Family Planning Distribution Programs -- 8 Oral Rehydration Therapy: Implementation Issues in Community-Based Distribution Programs -- 9 Oral Fluid Therapy and Diarrheal Mortality Among Children in Egyptian Villages -- PART FOUR ANTIHELMINTHICS IN CBD PROGRAMS -- 10 Antihelminthic Therapy in Community- Based Family Planning and Health Projects -- 11 Community-Based Distribution: The Case of Colombia -- 12 Sociedade Civil Bem-Estar Familiar No Brasil (BEMFAM): Review of an Integrated Family Planning and Antihelminthic Therapy Project in Piaui State, Brazil -- PART FIVE NUTRITION ACTIVITIES IN CBD PROGRAMS -- 13 Nutrition Activities in Community-Based Projects -- 14 Community-Based Nutrition Programs -- 15 Nutrition and Family Planning: An Integrated Program in Bali, Indonesia -- 16 Nutrition, Family Planning and Health Components of the Guatemalan Program of Primary Health Care (SINAPS) -- PART SIX IMMUNIZATION IN CBD PROGRAMS.

We examined 104 torture victims, 99 of whom were from Chile. Most of our patients were young men who had been arrested for political reasons. All the patients had been beaten; other common methods of torture included the application of electricity, cigaret burns, forced physical activity resulting in exhaustion, threats of death, sham execution and isolation. The only signs specific to torture were picana (electrical burn scars) and scars from cigaret burns. The most common psychological sequelae were anxiety, insomnia and recurrent nightmares. Psychological symptoms were similar to those documented in other populations who have suffered severe trauma.

A prospective study conducted between 1995 and 1998 assessed trends in contraceptive use in rural Rakai District, Uganda. Over a period of 30 months, women's use of modern contraceptives increased significantly from 11 percent to 20 percent. Male condom use increased from 10 percent to 17 percent. The prevalence of pregnancy among sexually active women 15–49 declined significantly from 15 percent to 13 percent. Women practicing family planning for pregnancy prevention were predominantly in the 20–39‐year age group, married, better educated, and had higher parity than others, whereas women or men adopting condoms were predominantly young, unmarried, and better educated. Condom use was particularly high among individuals reporting multiple sexual partners or extramarital relationships. Contraceptive use was higher among women who desired fewer children, among those who wished to space or terminate childbearing, and among women with previous experience of unwanted births or abortions. Self‐perception of HIV risk increased condom use, but HIV testing and counseling had only modest effects. Contraception for pregnancy prevention and for HIV/STD prophylaxis are complementary.

A randomized community trial of a family planning outreach program was conducted in Rakai District, Uganda. Five communities received standard services; six intervention communities received additional family planning information, counseling, and contraceptive methods from government service providers and community‐based volunteer agents using social marketing and other strategies. Condom use was promoted in all of the communities. The community‐based family planning outreach program was implemented in two phases—1999–2000 (early) and 2001 (late)—and its impact was evaluated by means of population surveys in 2002–03. At follow‐up, hormonal contraceptive prevalence was 23 percent in the intervention communities, compared with 20 percent in the control communities. The differential was greater in the early‐intervention communities than the late‐intervention communities. Pregnancy rates at follow‐up were 15 percent in the control and 13 percent in the intervention communities. No differentials in condom use were found between study arms. Family planning outreach via social marketing can significantly increase hormonal contraceptive use and decrease pregnancy rates, but the impact of this outreach program was modest.

Abstract Background In Kasensero fishing community, home of the first recorded case of HIV in Uganda, HIV transmission remains high with an incidence of 4.3 and 3.1 per 100 person-years in women and men, respectively, and an HIV prevalence of 44 %, reaching up to 74 % among female sex workers. We explored the social contextual factors for the high HIV transmission at Kasensero to inform future policy and preventive interventions. Methods We conducted 20 in-depth interviews, including both HIV positive and HIV negative respondents, and 12 focus-group discussions involving a total of 92 respondents from the Kasensero fishing community from April-September 2014. Content analysis was performed to identify recurrent themes. Results Our findings suggest that the high HIV transmission in Kasensero is a complex function of eight themes including; positive/negative attitudes about HIV and combination HIV prevention such as the demand for services versus ART/circumcision disinhibition; HIV depository; Multiple partners; Frequent unprotected sex; Clothing; Parental behaviors; Pressure within the sex industry; and Cross generational sex. Conclusions The current combination HIV prevention services by the RHSP need to be enhanced with more government involvement including ensuring sustainable supply of ART and circumcision services since they are reportedly highly demanded. Community involvement through the engagement of popular peers could also help in the campaign to change the HIV predisposing culture, misconceptions and risky social norms of the population. Social Context HIV Transmission Fishing Community.

AbstractIntroduction: To assess progress towards the UNAIDS 90–90–90 initiative targets, we examined the HIV care cascade in the population‐based Rakai Community Cohort Study (RCCS) in rural Uganda and examined differences between sub‐groups.Methods: Self‐reports and clinical records were used to assess the proportion achieving each stage in the cascade. Statistical inference based on a χ2 test for categorical variables and modified Poisson regression were used to estimate prevalence risk ratios (PRRs) and 95% confidence intervals (CI) for enrolment into care and initiating antiretroviral therapy (ART).Results: From September 2013 through December 2015, 3,666 HIV‐positive participants were identified in the RCCS. As of December 2015, 98% had received HIV Counseling and Testing (HCT), 74% were enrolled in HIV care, and 63% had initiated ART of whom 92% were virally suppressed after 12 months on ART. Engagement in care was lower among men than women (enrolment in care: adjPRR 0.84, 95% CI 0.77–0.91; ART initiation: adjPRR 0.75, 95% CI 0.69–0.82), persons aged 15–24 compared to those aged 30–39 (enrolment: adjPRR 0.72, 95% CI 0.63–0.82; ART: adjPRR 0.69, 95%CI 0.60–0.80), unmarried persons (enrolment: adjPRR 0.84, 95% CI 0.71–0.99; ART adjPRR 0.80, 95% CI 0.66–0.95), and new in‐migrants (enrolment: adjPRR 0.75, 95% CI 0.67–0.83; ART: adjPRR 0.76, 95% CI 0.67–0.85). This cohort achieved 98–65–92 towards the UNAIDS "90–90–90" targets with an estimated 58% of the entire HIV‐positive RCCS population virally suppressed.Conclusions: This cohort achieved over 90% in both HCT and viral suppression among ART users, but only 65% in initiating ART, likely due to both an ART eligibility criterion of <500 CD4 cells/mL and suboptimal entry into care among men, younger individuals, and in‐migrants. Interventions are needed to promote enrolment in HIV care, particular for hard‐to‐reach sub‐populations.