Suchergebnisse

This study examined the trend in extreme weather event related mortality reported in India during 2001–14 and explored the regional, age and sex differentials in such fatalities. We used age and sex-segregated data on the number of accidental deaths by natural causes released by Government of India under the National Data Sharing and Accessibility Policy. Various extreme weather events were grouped into five broad categories: cold wave, extreme precipitation, heat wave, lightning, and tropical cyclone. During 2001–14, 25% of all accidental deaths due to natural causes happened as a result of extreme weather events. Deaths due to extreme precipitation and tropical cyclones declined over time, whereas increasing trend was observed for lightning, and extreme temperature conditions. Most of the extreme weather event induced deaths were due to lightning, followed by extreme precipitation and temperature extremes. The burden of death was highest in the central part of India. States of Andhra Pradesh, Bihar, Uttar Pradesh, Maharashtra and West Bengal were affected the most by extreme weather events. More males and older population died than their counterparts. Findings suggest that people are adaptive to some extreme weather events such as cold wave and cyclones; whereas adaptation and coping with the heat wave and extreme precipitation seems to be less. Building awareness on the adaptive mechanisms to different extremes and a community-centered alert system can help in reducing fatalities due to extreme weather events.

Assam state in north-eastern India experiences annual floods which displace people, destroy crops, kill livestock and damage infrastructure. Dependence on natural resource-based livelihoods in an area that is also less developed makes local households vulnerable to floods. Lakhimpur district of Assam is among the worst flood-affected districts in the state. Remittance inflow increases in the aftermath of the floods that occur in this area and is used to procure provisions, rebuild livelihoods and repair houses. In action research conducted by the International Centre for Integrated Mountain Development's Himalayan Climate Change Adaptation Programme with the Institute of Integrated Resource Management, and Swayam Sikshan Prayog, women recipients of remittances are envisaged as the household level change-makers. Financial literacy training in particular aims to maximise the financial returns, avoid unnecessary expenses and support saving in the recipient households. The training on flood preparedness envisages training the women in aligning flood preparedness with the savings plan. Adapted from the source document.

Background & Objectives: Providing sexually transmitted infection (STI) services to female sex workers (FSWs) in rural and resource constrained settings is a challenge. This paper describes an approach to address this challenge through a partnership with government health facilities, and examines the effect of this partnership on the utilization of STI services by FSWs in Andhra Pradesh, India. Methods: Partnerships were formed with 46 government clinics located in rural areas for providing STI treatment to FSWs in 2007. Government health facilities were supported by local and State level non-government organizations (NGOs) through provision of medicines, training of medical staff, outreach in the communities, and other coordination activities. Data from programme monitoring and behaviour tracking survey were used to examine the accessibility and acceptability in utilization of STI services from partnership clinics. Results: The number of FSWs accessing services at the partnership clinics increased from 1627 in 2007 to over 15,000 in 2010. The average number of annual visits by FSWs to these clinics in 2010 was 3.4. In opinion surveys, the majority of FSWs accessing services at the partnership clinics expressed confidence that they would continue to receive effective services from the government facilities even if the programme terminates. The overall attitude of FSWs to visit government clinics was more positive among FSWs from partnership clinic areas compared to those from non-partnership clinic areas. Interpretation & Conclusions: The partnership mechanism between the NGO-supported HIV prevention programme and government clinic facilities appeared to be a promising opportunity to provide timely and accessible STI services for FSWs living in rural and remote areas.

Background: The Knowledge Network project was launched in 2010 to build evidence on the HIV epidemic by using the data generated by HIV programme implementing organisations in India. This paper describes the implementation of the programme and the strategies adopted to enhance the capacity of individuals to document and publish HIV prevention programme learnings. Further, it discusses the outcomes of the initiative. Methods: A multipronged approach was adopted, where a group of experts were brought together to collaborate with programme implementing organisations, review available data, develop research questions and guide peer-reviewed publications. Further, scientific writing courses were conducted to support individuals from HIV programme implementing organisations as well as educational and government organisations (mentees) to build the documentation capacity of individuals leading programme implementation and current and future researchers. The impact and quality of evidence generated was measured by examining the number of papers published, the number of citations, and the number of papers with at least 10 citations. Additionally, course participants' responses to open-ended questions in the anonymous course evaluation questionnaires are presented as verbatim quotes. Results: Overall, 99 papers on HIV programmatic learnings from India were finalised under the programme, of which 95 have been published. In all, 67 papers were co-authored by mentees. Most papers were published in high-impact factor (1 or more) journals and 72% were cited at least once in the literature. The main themes documented include key populations' HIV risk, HIV risk of general population groups, HIV/STI service delivery models and community mobilisation interventions. Conclusion: The study demonstrates that an integrated approach, involving partnership, capacity-building and mentorship, can maximise the use of available data and build the evidence base on HIV programmatic learnings. The capacity-building model adopted in the ...

Objective: To examine the effectiveness of a multilevel intervention to reduce HIV stigma among alcohol consuming men living with HIV in India. Design: A crossover randomized controlled trial in four sites. Setting: Government ART centres (ARTCs) offering core services in the greater Mumbai area. Participants: Seven hundred and fifty two (188 per site) alcohol-consuming male PLHIV on ART were recruited. Intervention: Multilevel intervention to reduce alcohol consumption and promote adherence by addressing stigma, implemented at the individual (individual counselling, IC), group (group intervention, GI) and community levels (collective advocacy, CA) in three distinct sequences over three cycles of 9 months each. Main outcome measure: HIV stigma, measured using the 16-item Berger Stigma scale. Methods: The article examines the effectiveness of the interventions to reduce stigma using Linear Mixed Model regression. Results: At baseline, 57% of participants had moderate-high levels of stigma (scores > 40). All three counseling interventions were effective in reducing stigma when delivered individually, in the first cycle (collective advocacy: βcoeff = −9.71; p < 0.001; group intervention: βcoeff = −5.22; p < 0.001; individual counselling: βcoeff = −4.43; p < 0.001). At then end of the second cycle, effects from the first cycle were sustained with no significant change in stigma scores. At the end of the third cycle, the site, which received CA+IC+GI sequence had maximum reduction in stigma scores (βcoeff = −10.29; p < 0.001), followed by GI+CA+IC (βcoeff = −8.23, p < 0.001). Conclusion: Baseline findings suggest that stigma remains a problem even with experienced patients, despite advances in treatment and adherence. Results of multilevel stigma reduction interventions argue for inclusion in HIV prevention and treatment program.

SummaryThis paper assesses the reasons for entry into sex work and its association with HIV risk behaviours among mobile female sex workers (FSWs) in India. Data were collected from a cross-sectional survey conducted in 22 districts across four high HIV prevalence states in India during 2007–2008. Analyses were limited to 5498 eligible mobile FSWs. The reasons given by FSWs for entering sex work and associations with socio-demographic characteristics were assessed. Reported reasons for entering sex work include poor or deprived economic conditions; negative social circumstances in life; own choice; force by an external person; and family tradition. The results from multivariate analyses indicate that those FSWs who entered sex work due to poor economic conditions or negative social circumstances in life or force demonstrated elevated levels of current inconsistent condom use as well as in the past in comparison with those FSWs who reported entering sex work by choice or family tradition. This finding indicates the need for a careful assessment of the pre-entry contexts among HIV prevention interventions since these factors may continue to hinder the effectiveness of efforts to reduce the spread of HIV/AIDS in India and elsewhere.