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A prominent liberal explanation for why states join international organizations is to advance norms that such organizations represent. The authors examine the patterns of membership on the now-defunct United Nations Human Rights Commission (now the UN Human Rights Council). In regions where democratic norms did not hold sway, members were elected to degrade human rights norms. Illiberal states sought seats to shield themselves or neighbors from censure by the Commission. As regions became more democratic, it became harder for states with poor records to be elected and easier for states with better human rights records to be elected.

The South's partisan shift from solidly Democratic to leaning Republican is one of the biggest transformations in American political history. This paper explores four explanations for this change: ideological self-identification & issue positions, changes in the ideological makeup of the parties, white southerners becoming more conservative, & conservative racial attitudes. The paper provides strong support for an ideological based realignment & little support for the alternative explanations. Overall, attitudes about the size of government & opinions about defense spending were the issues most highly correlated with partisan identification. Tables, Figures, References. Adapted from the source document.

The South's partisan shift from solidly Democratic to leaning Republican is one of the biggest transformations in American political history. This paper explores four explanations for this change: ideological self-identification and issue positions, changes in the ideological makeup of the parties, white southerners becoming more conservative, and conservative racial attitudes. The paper provides strong support for an ideological based realignment and little support for the alternative explanations. Overall, attitudes about the size of government and opinions about defense spending were the issues most highly correlated with partisan identification.

Part One: Approaching the Subject. - 1. Intrastate Conflicts and the Problem of Political Will. - Michael Lund. - 2. Nonofficial Conflict Resolution and Sustainable Peace: Theory of Practice. - Michael Lund. - Part Two: Assessing Country Cases. - 3. Estonia: Psychopolitical Dialogue for Conflict Prevention. - Susan H. Allen. - 4. Guyana: Can Dialogues Change the Course of a Nation?. - Michael Lund. - 5. Tajikistan: Peace Secured, but the State of Our Dreams?. - Anna Matveeva. - 6. Sri Lanka: When Negotiations Fail-Talks for the Sake of Talks, War for the Sake of Peace. - Hannes Siebert. - 7. Cyprus: The Harvard Study Group-Contributions to an Unfulfilled Peace Process. - Diana Chigas. - 8. Burundi: The Burundi Leadership and Training Program. - Susanna Campbell and Peter Uvin. - Part Three: Findings and Implications. - 9. Learning from the Cases: Impacts and Explanations. - Michael Lund. - 10. Contemporary Implications: From Trust-Building to Institution-Building. - Michael Lund

BACKGROUND: There is unmet need for family planning in Rwanda. We previously developed an evidence-based couples' family planning counseling (C)FPC program in the capital city that combines: (1) fertility goal-based family planning counseling with a focus on long-acting reversible contraceptive (LARC) for couples wishing to delay pregnancy; (2) health center capacity building for provision of LARC methods, and (3) LARC promotion by community health workers (CHW) trained in community-based provision of oral and injectable contraception. From 2015 to 2016, this service was integrated into eight government health centers in Kigali, reaching 6072 clients and resulting in 5743 LARC insertions. METHODS: From May to July 2016, we conducted cross-sectional health center needs assessments in 30 rural health centers using surveys, key informant interviews, logbook extraction, and structured observations. The assessment focused on the infrastructure, materials, and human resources needed for LARC demand creation and provision. RESULTS: Few nurses had received training in LARC insertion [41% implant, 27% intrauterine device (IUD)]. All health centers reported working with CHW, but none trained in LARC promotion. Health centers had limited numbers of IUDs (median 10), implants (median 39), functional gynecological exam tables (median 2), and lamps for viewing the cervix (median 0). Many did not have backup power supplies (40%). Most health centers reported no funding partners for family planning assistance (60%). Per national guidelines, couples' voluntary HIV counseling and testing (CVCT) was provided at the first antenatal visit at all clinics, reaching over 80% of pregnant women and their partners. However, only 10% of health centers had integrated family planning and HIV services. CONCLUSIONS: To successfully implement (C)FPC and LARC services in rural health centers across Rwanda, material and human resource capacity for LARC provision will need to be greatly strengthened through equipment (gynecological exam tables, ...

BackgroundWith the accessibility of prevention of mother to child transmission (PMTCT) services in sub‐Saharan Africa, more women are being tested for HIV in antenatal care settings. Involving partners in the counselling and testing process could help prevent horizontal and vertical transmission of HIV. This study was conducted to assess the feasibility of couples' voluntary counseling and testing (CVCT) in antenatal care and to measure compliance with PMTCT.MethodsA prospective cohort study was conducted over eight months at two public antenatal clinics in Kigali, Rwanda, and Lusaka, Zambia. A convenience sample of 3625 pregnant women was enrolled. Of these, 1054 women were lost to follow up. The intervention consisted of same‐day individual voluntary counselling and testing (VCT) and weekend CVCT; HIV‐positive participants received nevirapine tablets. In Kigali, nevirapine syrup was provided in the labour and delivery ward; in Lusaka, nevirapine syrup was supplied in pre‐measured single‐dose syringes. The main outcome measures were nurse midwife‐recorded deliveries and reported nevirapine use.ResultsIn eight months, 1940 women enrolled in Kigali (984 VCT, 956 CVCT) and 1685 women enrolled in Lusaka (1022 VCT, 663 CVCT). HIV prevalence was 14% in Kigali, and 27% in Lusaka. Loss to follow up was more common in Kigali than Lusaka (33% vs. 24%, p = 0.000). In Lusaka, HIV‐positive and HIV‐negative women had significantly different loss‐to‐follow‐up rates (30% vs. 22%, p = 0.002). CVCT was associated with reduced loss to follow up: in Kigali, 31% of couples versus 36% of women testing alone (p = 0.011); and in Lusaka, 22% of couples versus 25% of women testing alone (p = 0.137). Among HIV‐positive women with follow up, CVCT had no impact on nevirapine use (86‐89% in Kigali; 78‐79% in Lusaka).ConclusionsWeekend CVCT, though new, was feasible in both capital cities. The beneficial impact of CVCT on loss to follow up was significant, while nevirapine compliance was similar in women tested alone or with their partners. Pre‐measured nevirapine syrup syringes provided flexibility to HIV‐positive mothers in Lusaka, but may have contributed to study loss to follow up. These two prevention interventions remain a challenge, with CVCT still operating without supportive government policy in Zambia.

Little is known about how the information presented in the informed consent process influences study outcomes among participants. This study examines the influence of informed consent content on reported baseline contraceptive knowledge and concerns among two groups of HIV‐serodiscordant and seroconcordant HIV‐positive couples enrolled in research projects at an HIV research center in Lusaka, Zambia. We found significant differences in the reporting of contraceptive knowledge and concerns between couples viewing consent materials that included detailed information about contraception and those viewing consent materials that lacked the detailed information. We conclude that the design of informed consent materials should strike a balance between ensuring that participants give truly informed consent and educating participants in ways that do not compromise the assessment of the impact of behavioral interventions.

With the expansion of couples' voluntary HIV counseling and testing (CVCT) in urban Zambia, there is a growing need to evaluate CVCT provider trainings to ensure that couples are receiving quality counseling and care. We evaluated provider knowledge scores, pre- and post-training and predictors of pre- and post-training test scores. Providers operating in 67 government clinics in four Copperbelt Province cities were trained from 2008 to 2013 in three domains: counseling, rapid HIV laboratory testing and data management. Trainees received pre- and post-training tests on domain-specific topics. Pre- and post-training test scores were tabulated by provider demographics and training type, and paired t-tests evaluated differences in pre- and post-training test scores. Multivariable ANCOVA determined predictors of pre- and post-training test scores. We trained 1226 providers, and average test scores increased from 68.8% pre-training to 83.8% post-training (p < 0.001). Test scores increased significantly for every demographic group and training type (p < 0.001) with one exception—test scores did not significantly increase for those receiving counseling or data management training who had less than a high school education. In multivariable analysis, higher educational level and having a medical background were predictive of a higher pre-test score; higher pre-test scores and having a medical background were predictive of higher post-test scores. Pre- and post-test assessments are critical to ensure quality services, particularly as task-shifting from medical to lay staff becomes more common. Assessments showed that our CVCT trainings are successful at increasing knowledge, and that those with lower education may benefit from repeat trainings.

OBJECTIVE: This study aims to understand the basis of continued HIV-1 transmission in Zambian and Rwandan HIV-1 discordant couples in the context of ART. DESIGN: We identified 9 Zambian and 7 Rwandan acutely-infected, epidemiologically-linked couples from government CVCT clinics where transmitting partners reported being on ART near the time of transmission. METHODS: We quantified viral load (VL) and plasma antiretroviral (ARV) drug concentrations near the time of transmission and used these as surrogate measures for adherence. We also sequenced the polymerase gene from both donor and recipient partners to determine the presence of drug resistance mutations (DRM). RESULTS: In Zambia, all transmitting partners had detectable VL and 8/9 were not on therapeutic ARV regimens. In the remaining couple, despite being on a therapeutic regimen, DRM were present and transmitted. In Rwanda, although 6/7 transmitting partners had detectable VL, therapeutic levels of ARV were detected in 4/7, but were accompanied by DRM. In the remaining 3 couples, either no ARV or sub-therapeutic regimens were detected. CONCLUSIONS: A reduction of ART effectiveness in non-trial settings was associated with lack of ARVs in plasma and detectable VL, as well as DR. In Zambia, where CVCT is not widely implemented, inconsistent adherence was high in couples unaware of their HIV discordance. In Rwanda, where CVCT is deployed country-wide, virologic failure was associated with DR and subsequent transmission. Together, these findings suggest that increasing ART availability in resource-limited settings without risk reduction strategies that promote adherence, may not be sufficient to control the HIV epidemic in the post-ART era.

BACKGROUND: Integrating family planning interventions with HIV studies in developing countries has been shown to prevent mother-to-child HIV transmission and simultaneously reduce HIV and unintended pregnancy in high-risk populations. As part of a prospective cohort study on HIV incidence and risk factors in Zambian women having unprotected sex, we also offered family planning counseling and immediate access to long-acting reversible contraceptives. Although long-acting reversible contraceptives are the most effective form of contraception, many Zambian women are limited to oral or injectable methods due to lack of knowledge or method availability. This project offers single mothers enrolled in a cohort study information about and access to long-acting reversible contraceptives at enrollment and at each follow-up visit. OBJECTIVE: This study evaluates how fertility intentions affect long-acting reversible contraceptive utilization in HIV-negative single mothers in Zambia. Our primary outcome was long-acting reversible contraceptive use throughout study participation. We also estimated rates of long-acting reversible contraceptive uptake and discontinuation. We specifically studied single mothers because they are at high risk for unintended pregnancy, which can have significant negative ramifications on their financial, social and psychological circumstances. STUDY DESIGN: From 2012–2017, Zambia Emory HIV Research Project recruited 521 HIV-negative single mothers between the ages of 18–45 years from government clinics in Lusaka and Ndola, Zambia's two largest cities. Participants were followed every three months for up to five years. At each visit, we discussed fertility goals and contraceptive options and offered a long-acting reversible method to any woman who was not pregnant or already using a long-acting reversible or permanent contraceptive method. Data was collected on demographic factors, sexual behavior and reproductive history. Multivariable logistic regression was used to model baseline fertility ...