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The Group’s project book order will increase to RM1.9 billion Bina Puri Holdings Bhd (BPURI) has successfully secured a new international contract worth Nepalese Rupee NPR 5.2 billion (equivalent RM183 million) for the New Construction Project of Supreme Court Building Complex at Ramshahpath, Kathmandu, a project funded by the Government of Nepal. A filing to Bursa Malaysia today showed that Bina Puri together with Kalika Construction Pvt Ltd and Samanantar Nirman Sewa Pvt Ltd had entered into a joint venture agreement to form “Bina Puri – Kalika – Samanantar JV” to construct the project. The construction project is awarded by the Supreme Court of Nepal with a contract period of 36 months. It will consist of 7-storey building including two basements, RCC framed structure building with complete finishing, landscaping and MEP (Mechanical, Plumbing and Electrical Works along with firefighting) works. Group Executive Director Datuk Matthew Tee said: “We have been actively participating in the tender for projects both local and overseas to further replenish our orderbook. With the latest award mentioned, the Group’s latest project book order will increase to RM1.9 billion.” Kalika Construction Pvt Ltd is a leading well-known “A” class construction company of Nepal having over 40 years of experience in all types of construction works. It was founded in 1976 and its parent company, Kalika Group operates in five business sectors: Hydropower, Construction, Software Outsourcing, International Trading and FM Radio/Media. The Kalika Group is one of Nepal’s largest and most respected business conglomerates. Whereas Samanantar Nirman Sewa Pvt. Ltd. was founded in 1993 and is currently one of Nepal’s growing and most reputable construction companies by successfully delivering a range of projects for government and other market sectors. The works completed by the company comprises of government building, hospitals, water supply system, river protection, roads and infrastructures development in different sectors. According to the management of Bina Puri, the company’s affiliation with Kalika is through both countries’ membership in the International Federation of Asian and Western Pacific Contractors’ Associations (IFAWPCA) represented by the Master Builders Association Malaysia (MBAM) and Federation of Contractors Associations of Nepal (FCAN). IFAWPCA groups together the fraternity of builders from nineteen (19) member countries in the Asia and Western Pacific region. A dynamic international organization, IFAWPCA plays a critical role in promoting international fellowship and cooperation; in developing beneficial relationships between governments and contractors in the region, and in establishing cooperative working arrangements in the furtherance of civil and building construction projects. Bina Puri is among the earliest Malaysian construction company to venture overseas since 1995. Bina Puri had previously completed a five-star Hyatt Regency Hotel in Kathmandu, Nepal in April 2000 valued at RM39 million. Among the shareholders of the hotel is the Asian Development Bank (ADB). To date the Group has successfully carried out numbers of construction projects in several foreign countries. Among the notable completed projects are three highways in India including the Vijayawada-Eluru Expressway, Tada-Nellore Expressway in Andhra Pradesh and the Chittorgarh-Mangalwar Highway in Rajasthan, Malaysian Chancery Building and Official Ambassador’s Residence in Beijing, China and Access Road for the New Bangkok International Airport in Bangkok, Thailand. Bina Puri have also completed about 30,000 units of low cost housing and condominiums in various locations in Thailand; 2 Blocks of 45-storey residential towers in Abu Dhabi, UAE; 174 units Villas for the Defense Housing Authority in Lahore, Pakistan and more than 3,000 houses for the National Housing Scheme of Brunei from the Brunei Economic Development Board. Currently undergoing is the construction of the Malaysian Embassy Complex in Moscow, Russia. About Bina Puri Bina Puri Holdings Bhd (BPURI) (MY:5932; BIN.MK; BPUR.KL) is a public listed company on the Main Board of Bursa Malaysia with more than 46 years of work experience in civil and building construction both locally and internationally. The Group’s diverse business activities include investment holdings, civil and building engineering management, property development, highway concession, quarry operations, manufacturing of construction materials, utilities and hospitality management. Bina Puri has successfully completed projects such as roads and highways, bridges and interchanges, waterworks, land reclamation works, residential and commercial buildings, hotels, hospitals, airports and government complexes. The group has international presence in which it has successfully undertaken projects in Cambodia, China, Brunei Darussalam, United Arabs Emirates, Saudi Arabia, Pakistan, India, Indonesia and Thailand. Bina Puri’s notable investment portfolios include the 33km toll highway linking KL-Kuala Selangor Expressway, the Main Place Residence and Mall at USJ 21, and power plants in Indonesia. www.binapuri.com.my

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Last modified: 2019-11-11 by ivan sache Keywords: muğla | Links: FOTW homepage | search | disclaimer and copyright | write us | mirrors Flag of Muğla, horizontal and vertical versions - Images by Tomislav Šipek, 8 January 2018 The flag of Muğla (photo), used horizontally or vertically, is white with the municipality's emblem. "T.C." stands for "Türkiye Cumhuriyeti", "Republic of Turkey". "Büyükşehir Belediyesi" means "Metropolitan municipality". Tomislav Šipek, 8 January 2018 Flag of MUSKİ - Image by Tomislav Šipek, 29 January 2018 The flag of MUSKİ (photo) is white with the administration's logo. Tomislav Šipek, 29 January 2018 Flag of MSKÜ - Image by Ivan Sache, 21 January 2018 MSKÜ (website) was established in 1992 as a state university with four proposed faculties: the Faculty of Arts & Sciences and Humanities, the Faculty of Economics & Administrative Sciences, the Faculty of Technical Education and the Faculty of Fisheries. Muğla School of Management, founded in 1975, originally affiliated with the Ankara Academy of Economics & Administrative Sciences, was the first higher education institution in Muğla. It then became the first faculty of Muğla Sıtkı Koçman University upon its establishment. In addition, Muğla Vocational School, founded in 1989 as part of İzmir 9 September University, joined Muğla University. MSKÜ is composed of 17 Faculties, 4 Schools, 4 Graduate Schools, and 13 Vocational Schools. MSKÜ is named for his main sponsor since 1999, the industrialist and philanthropist Sıtkı Davut Koçman (1912-2005). Koçman established several companies connected with mining industry (Koçtuğ Marine & Commerce Co., Köyceğiz Chrome Co., Bursa Toros Chrome Co., Kıyra Chrome Co.); his main success, however, was the establishment in 1957 of BMC Industrial and Commerce Co.; this was the first integrated automobile plant in Turkey, where diesel engine, cars, trucks and tractors were manufactured. In the 1960s, Koçman invested in the poultry rearing business. The flag of MSKÜ (photo, photo, photo, photo, photo, photo) is white with the university's emblem in the center. On some flags (photo, photo, photo), the emblem is framed in black. The emblem features a stylized representation of the M-shaped university's entrance gate (photo, The columns symbolize the magnificent historical and cultural heritage that can be traced throughout ages and cultures. The belts symbolize transition between past and present cultures. The blue lines symbolize Muğla’s sparkling sea. The pine tree symbolizes Muğla’s rich forests. "1992" is the year of establishment of the university. Ivan Sache, 21 January 2018 Flag of MUTSO - Image by Ivan Sache, 3 August 2019 The flag of MUTSO (photo, photo, photo) is white with the organization's emblem. Ivan Sache, 3 August 2019 The flag of Muğlaspor (Muğla Spor Kulübü) is white with the club's emblem (photo, The flag is also used with a green background (photos). The flag also exists horizontally divided white-green-white-green-white-green-white with the club's emblem (photo). Ivan Sache, 7 December 2016

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On May 20 and 21, 2009, the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened a workshop to discuss priorities for thalassemia research and clinical trials. Thalassemia major affects approximately 1,000 persons in the U.S., however, increased immigration to the U.S. is increasing the prevalence and broadening the demographics of thalassemia. The goal of the workshop was to identify clinical research needs and trials to reduce the burden of disease. Investigators, clinicians, and patient advocates identified priorities for clinical research and discussed study infrastructure and international collaborative opportunities. Key areas for the successful completion of clinical trials in thalassemia include: - Forming international collaborations to increase and expand patient recruitment - Keeping the goals, protocols and organizational structure as simple as possible - Facilitating cooperation among the investigators designing and conducting the studies and clinical research organizations with expertise in regulatory issues for each country - Enhancing protocol design by seeking input from thalassemia patients and families - Developing a framework that rewards key investigators for timely attainment of study milestones Meeting attendees identified high priority scientific areas including: - Studying chelation therapy to determine factors that may predispose to poor responses to chelation and determining optimal management of chelation therapy in children to prevent iron overload; preventing iron injury and identifying factors that modulate iron distribution and toxicity - Investigating the molecular and cellular mechanisms that underlie globin gene activation and silencing; developing robust laboratory drug screening techniques that are applicable to thalassemia - Determining the optimal period of bisphosphonate treatment to improve the low bone mass of thalassemia patients and studying the long-term safety profile of bisphosphonate therapy; investigating the risks and benefits of vitamin D therapy in children, adolescents and chronically transfused patients - Testing the feasibility and efficacy of haplo-identical transplantation for thalassemia; developing a reduced intensity transplantation regimen that will permit hematopoietic stem cell transplantation in a broader range of patients - Improving the efficiency of stem-cell targeted gene transfer; determining the degree of myelosuppression required for high-level engraftment of genetically modified stem cells Subcommittees of experts assembled before the workshop to develop opinions on five topics: - Iron Overload: Clinical Monitoring and Chelation Therapy - Fetal Hemoglobin - Stem Cell Transplantation - Gene Therapy - Endocrine Disorders/Bone Disease/Growth and Development Each subcommittee considered four questions: - What are the clinical research priorities currently facing the thalassemia community? - What are the most important clinical trials (Phase I, II, and III) that should be undertaken? - How can successful study completion and patient recruitment be optimized? - What is the role of international collaborations in thalassemia clinical research? The first day of the workshop, representatives from each subcommittee presented recommendations for clinical research priorities. On the second day of the workshop, experts in thalassemia clinical trial research described the current status of clinical trials conducted in the U.S. and Thailand. The workshop was co-chaired by Drs. Suthat Fucharoen of the Thalassemia Research Center, Institute of Science and Technology for Research and Development, Mahidol University, Thailand and Dr. Cheryl Hillery, Professor of Pediatrics at the Medical College of Wisconsin. The NHLBI Deputy Director, Dr. Susan Shurin, underscored the need for workshop attendees to address issues of public health, critical scientific questions and opportunities in thalassemia globally, such as the state of curative and supportive care, how to prolong longevity, and priorities for undertaking research activities that would yield the largest payoff for the most patients. Drs. Griffin Rodgers, Director, NIDDK, and Dr. W. Keith Hoots, Director, Division of Blood Diseases and Resources, NHLBI welcomed the participants and endorsed the need for a global approach to thalassemia clinical research. Information provided at the workshop will help inform NHLBI and NIDDK in the development of future thalassemia research initiatives. Iron Overload: Clinical Monitoring and Chelation Therapy - Chelation therapy studies should evaluate: combined and/or serial usage of licensed drugs such as deferasirox and deferoxamine or deferasirox and deferiprone; novel iron chelators; genetic or other factors that may predispose to poor chelation response; optimal management of chelation therapy in young children to prevent iron overload; optimal usage of T2* and magnetic resonance imaging to guide chelation therapy; and prospective long-term chelation compliance. - Studies should determine whether antioxidant therapies are beneficial in preventing iron injury. - Studies of hepcidin are needed in thalassemia animal models and patients to: understand the role of anemia, hypoxia, ineffective erythropoiesis and iron overload on hepcidin synthesis; determine whether measurement of plasma hepcidin has prognostic utility; and determine whether hepcidin agonists modify transfusional iron overload and decrease iron distribution to the heart and gastrointestinal tract. - Clinical studies are needed to: identify factors that modulate iron distribution and toxicity; study variations in distribution of extra-hepatic iron from patient to patient; determine genetic modifiers that may affect iron distribution; and examine environmental or treatment-related differences (other than chelation therapy) such as blood transfusion strategy that affect iron distribution. - Non-transferrin bound plasma iron (NTBI) should be studied to: better determine the mechanisms of cellular uptake; define the nature and speciation of NTBI; identify the factors determining NTBI levels; and clarify the relationship between NTBI and speciation with extra-hepatic iron distribution. - Magnetic resonance imaging studies should be conducted to study the relationship between endocrine iron loading and end-organ dysfunction. - Molecular and cellular studies are needed to better understand globin gene activation, switching and silencing. It is important to identify the drivers of globin activation and silencing to enable therapeutic interventions that are more locus restricted. - A central database of all compounds identified as having HbF induction potential and a central drug development resource should be developed. - Robust laboratory drug screening techniques need to be developed that are applicable to thalassemia. - Clinical trials should be undertaken with DNA methyl-transferase inhibitors and short-chain fatty acids. - The Electronic Infrastructure for Thalassemia Research Network (Ithanet), a Euro-mediterranean network of research centers conducting molecular and clinical research of thalassemia and related hemoglobinopathies, should be used for conducting international clinical trials. Endocrine Disorders/Bone Disease/Growth and Development - Low bone mass affects approximately two-thirds of thalassemia patients. Treatment with bisphosphonates improves the low bone mass of thalassemia patients, however, additional trials are needed, especially in children and adolescents, to determine the optimal duration, dose and schedule of treatment and a long-term safety profile of bisphosphonate therapy. - Trials of anti-resorptives, bone anabolic agents, vitamin D, physical activity, and combination therapies are needed for patients who fail to respond to bisphosphonate therapy. - Vitamin D abnormalities are prevalent in thalassemia. Studies are needed, particularly in children, adolescents and chronically transfused patients, to evaluate vitamin D dosage on bone mass, inflammation, immune responses and cardiac function. - Studies are needed to determine the effects of iron overload and chelation on gonadal function and fertility. - Trace element deficiencies (zinc, copper and selenium) are more common in thalassemia than healthy cohorts and have been linked to altered immune function and low bone mass. Deferiprone induces zinc deficiency in approximately 15 percent of thalassemia patients. Studies are needed to determine the effects of optimal deferasirox dosage on trace elements and the effect of micronutrient replacement on chelator efficacy. - Diabetes occurs in 10 percent of thalassemia patients. Studies are needed to define the cardiovascular complications of glucose abnormalities and to identify optimal treatment options for impaired glucose tolerance in aging thalassemia patients. Stem Cell Transplantation - More than 900 thalassemia patients have received sibling-matched blood or marrow hematopoietic stem cell (HPSC) transplants with an overall survival rate of 73 percent. Since only 25 percent of patients have a matched HSPC related donor, there is a vital need for alternative donors and transplantation strategies. Pilot studies are needed to test the safety and efficacy of haplo-identical transplantation and reduced intensity conditioning regimens. - Transplantation studies should evaluate the role of alloimmunization in transplant outcomes and optimal strategies to prevent and control graft versus host disease. - Prognostic factors which predict complications and early death in thalassemia should be refined to better identify transplantation risks. - For gene therapy to succeed in ß-thalassemia patients, clinically effective levels of vector-transduced, normal ß-globin gene expression and HPSC chimerism are necessary. Small scale, pilot clinical studies and concurrent primate studies are needed to improve the efficiency of HSPC-targeted gene transfer and to determine the myelosuppression level required for stable engraftment of genetically modified cells. - Patients should be carefully screened to identify those who have residual capacity for red cell production to enhance the efficacy of gene therapy. - Studies are needed to determine the safety and feasibility of cytokine (Granulocyte-Colony Stimulating Factor and other agents) mobilization and transduction of peripheral HSPC from thalassemia patients. The Thalassemia Clinical Research Network: Accomplishments and Challenges Janet Kwiatkowski, MD, Thalassemia Program, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine and Ellis Neufeld, M.D., Ph.D., Children's Hospital Boston reviewed the accomplishments and challenges of the Thalassemia Clinical Research Network (TCRN). The TCRN, funded by the NHLBI (2000-2005 and competitively renewed 2005-2010), consists of six core clinical sites, 26 satellite sites throughout the United States, Canada, and England, and a Data Coordinating Center (New England Research Institute). The TCRN's goal is to accelerate research in the management of thalassemia through multicenter trials. The TCRN strengths include: the thalassemia experts and statisticians who develop studies and identify important research goals and findings; access to a critical mass of patients for studies; a website that facilitates communication, data analysis and publications; collaborations between core and satellite sites, and with CDC Surveillance Project, the Cooley's Anemia Foundation, other countries, other networks, and pharmaceutical companies; and, support for junior investigators to perform and publish clinical studies. The TCRN developed a study Registry and the following Registry-based studies: - The Longitudinal Cohort Study (TLC) builds baseline data and other information from the Registry by adding annual data collection to describe genotype-phenotype variability, the prevalence and incidence of complications specific to thalassemia and its treatment, assessments of iron burden and therapeutic adherence, and quality of life. - Objectives of the Cross Sectional Observational Study of Low Bone Mass in Thalassemia are to determine the prevalence of low bone mass, fractures, and bone pain and evaluate the interaction of endocrine, genetic and environmental factors as well as transfusion and chelation regimens on the development of low bone mass. - The Pilot Study of Response of Oxidant-Stress Induced Injury and Mitochondrial Dysfunction Biomarkers to Treatment with Iron Chelators is an ancillary study to the Novartis ICL-670 107 study which estimates the magnitude of iron-induced oxidative stress and inflammation and compares deferoxamine with deferasirox treatments. - The Assessment of Pain Survey is a survey to assess the prevalence of pain in subjects with transfusion and non-transfusion dependent thalassemia. Five major interventional trials in the TCRN include: - Safety and efficacy of Peg-interferon and ribavirin for the treatment of hepatitis C - Phase 2 randomized, double-blind, placebo controlled trial comparing the effect of deferoxamine with and without oral deferiprone on left ventricular function in adults with transfusion-dependent thalassemia - Phase 2A study of subcutaneous decitabine in patients with thalassemia intermedia - Pilot study of oral sildenafil for the treatment of pulmonary hypertension in thalassemia - Reduced intensity unrelated donor HSPC transplantation protocol The major challenges for the TCRN include: the slow pace of protocol development, patient enrollment, data analysis and manuscript completion; the need to recruit patients from outside the U.S. because of the small number of thalassemia patients in the U.S.; and, difficulties for launching international sites (translation of numerous trial forms, differences in local regulatory authorities, indemnification and insurance requirements in the European Union). Facilitating NIH-Funded International Clinical Trials in Thalassemia Francis P. Crawley, MA, FFPM, Good Clinical Practices Alliance Europe reviewed the European Directive as it pertains to conducting clinical trials in the European Union (EU). EudraLex includes the rules governing medical products in the EU, however, clinical investigators also must also adhere to local and national rules. The International Good Clinical Practices (GCP) framework includes: general?International Council on Harmonization Good Clinical Practices and World Health Organization (WHO) Good Clinical Practices; regional/applied?U.S. Code of Federal Regulations and EU GCP; and national/applied?GCP guidelines apply to India, China, Russia, Singapore, Malaysia, Indonesia, South America, South Africa, and Turkey. The European Directive, implemented in 2001, directs national governments to implement laws on GCP in the conduct of clinical trials for medicinal projects for human use. This applies not only to pharmaceutical companies, but also to investigators conducting clinical trials. It defines the roles of the investigator, sponsor, competent authority (EU GCP inspections), and has a review timeline of 60 days from the date of receipt of a valid application to give its reasoned opinion. The structures and regulations differ in Member States for IRBs and ethics committees. Many of these countries have developed their own regulations for implementing the EU Directive. Differences among member states pose special challenges including: - Cooperation across member state borders and with third countries (including U.S.) - Education programs for Ethics Committee members - Reviewing Suspected/Unexpected Serious Adverse Reactions - Reviewing financial matters, including payments to subjects, investigators, and sites - Reviewing insurance and indemnity - Patient representation on Ethics Committees - Phase I clinical trials - Pediatric clinical trials Regulations governing pediatric clinical trials are similar to U.S. regulations. To undertake pediatric studies in Europe, the European Medicines Agency requires an early plan for review. The EU has regulations for orphan drug development. Major challenges include the lack of consistency across member states for: - The contents of the Clinical Trials Application - The definition of an Investigational Medicinal Product - The definition of substantial amendment - Good Manufacturing Practices requirements for Investigational Medicinal Medicinal Products Clinical Trials in Thalassemia: Imperatives and Insights from the Community Gina Cioffi, National Cooley's Anemia Foundation, reviewed the Cooley's Anemia Foundation (CAF) perspective of clinical trials and provided recommendations to enhance patient enrollment in studies. Patient recruitment and enrollment in clinical trials is a major challenge. Among people who suffer from severe chronic illness, only 6 percent participate in clinical trials. Almost 50 percent of trial delays result from patient enrollment problems and 86 percent of all U.S. clinical studies fail to recruit the required number of subjects on time. Industry wide there is a 20-30 percent patient dropout rate in Phase II/III studies. The CAF informs patients and families about trials to further the conversation between the patient and the clinical investigator and the patient and his/her physician without dispensing medical advice or encouraging consent to take part in a trial. The CAF maintains a balance in presenting studies available without overtly promoting an opportunity through a Thalassemia Action Group newsletter, conferences and an interactive website listing studies and other relevant information. Consideration of the patient point of view can enhance an investigational concept and lead to more rapid enrollment. Enrollment success depends on a good fit among the protocol design, participant sites, and the target population. The major challenges for patient are: - Lack of patient/family role in design - Participating while working - Lack of follow up on trial conclusions. Patients would like trials designed more to their convenience: - Allow for hospital stays no longer than 3 days - Conduct studies outside of TCRN sites - Facilitate transportation. - Consider motivators such as: - Financial incentives - Trials offering "hope" - More assurance about safety - More participation from younger adult patients - More direct benefit to the adult patients - A report showing academic and career success among patients Recommendations for specific areas of study include: - Effectiveness of L1 in raising T2* - Quality of Life studies - Additional study of chelation therapy - Additional study on noninvasive iron measurements - Clotting Risks - Gene therapy - Patients with low ferritins and abnormal T2* Thalassemia in Southeast Asia - An Overview Suthat Fucharoen, MD, Thalassemia Research Center, Institute of Science and Technology for Research and Development, Mahidol University provided on overview of thalassemia demographics in Southeast Asia. There is a high prevalence of thalassemia and abnormal hemoglobin in Southeast Asia with variability of different ethnic-specific mutations in each country: ?-, ?-thalassemia and abnormal hemoglobins (Hb) such as Hb E and Hb Constant Spring are common in Southeast Asia; ?-thalassemia and Hb Constant Spring are scattered throughout the region at 1-8 percent, however, ?-thalassemia and Hb E are focal. In the northeastern part of Southeast Asia, near Laos and north Thailand, ?-thalassemia occurs at frequencies of 30-40 percent. Hb E is common among the Thai-speaking population living at the junction of Cambodia, Laos, and Thailand where the prevalence of Hb E reaches 50-60 percent. Thalassemia presents an increasingly severe public health burden for many countries in Southeast Asia. - It is difficult to diagnose thalassemia at small health care units because of the heterogeneity of the disease and because carriers have no symptoms. - Treatment of severe thalassemia with regular blood transfusions and iron chelation is expensive. Therapy is usually performed only in large cities, which requires some patients to travel long distances. Bone marrow transplantation, the only cure, is less expensive than long-term transfusion and iron chelation therapy. - Policies addressing prevention, such as screening for all pregnant women, would be more cost effective than therapy. - It is difficult to persuade international health agencies and governments that thalassemia is a serious public health issue when compared with communicable diseases that the countries are handling. A WHO report adopted by the 57th World Health Assembly in 2004, Genomics and World Health, recommended that local networks should be established to help member countries evolve services. An Asian Network for Thalassemia Control was formed to disseminate good practice in the control and management of thalassemia in Asia and to provide a central forum for interacting with individual governments and international health agencies to provide support for the objectives. The objectives are: - Develop and disseminate adequate screening techniques for determining the frequency of the different forms of thalassemia in Asian countries, - Develop education and screening programs for prenatal diagnosis of thalassemia, - Develop more adequate approaches to treatment. Recent Clinical Trials of Chelation Therapy in Thailand Vip Viprakasit, MD, DPhil, FRCPT, Division of Haematology-Oncology and WHO Collaborating Centre for the Control of Thalassaemia and Haemoglobinopathies, Siriraj Hospital, Mahidol University Bangkok, Thailand reviewed the status of clinical trials of chelation therapy in Thailand. There are at least 500,000 people with thalassemia in Thailand, with approximately 12,000 new cases annually, and 48,000 at-risk pregnancies. More than 20,000 transfusion-dependent patients require regular transfusion and life-long chelation therapy. An analysis of treatment compliance and related health and social determining factors in Thai thalassemia patients under long-term deferrioxamine (DFO) administration at Faculty of Medicine Siriraj Hospital, Bangkok revealed that 40 percent of 112 pediatric patients with severe thalassemia (49 percent receiving DFO therapy for 2-7 yrs and 51 percent receiving DFO therapy for 7-17 yrs) were reported by their parents as having good compliance with DFO therapy. However, only 14 percent of the cases studied had an average serum ferritin (assayed during the prior year) of less than 2,500 ng/ml (a surrogate marker for adequate chelation therapy with well-controlled iron burden). Thailand is an ideal location for conducting an iron chelation trial because of its large patient population and its experience with: operating clinical studies under the GCP standard; thalassemia patient care; protecting patient safety; and excellent technical and MRI capabilities. Thailand has four transplant centers and is conducting a multi-center national study on Thai Government-made oral chelator (GPO-L-ONE or deferiprone, DFP) and also international studies on oral chelation therapy on Exjade (deferasirox, DFX). Recent clinical studies on iron chelation therapy in Thailand include ICL670 (Exjade) trials: - 2409 (EPIC) & Cardiac sub-studies - 2206 (DFO VS Exjade) - 2209 (Exjade in Thal Intermediate) - 2411 (Exjade in young patients; 2-6yrs) - Exjade in other anemias: myelodysplastic syndrome.; and pre-transplantation-DFX Thailand also has undertaken multi-center national studies for clinical efficacy and adverse effects of GPO-L-ONE (deferiprone). This trial, which takes place at five centers in Bangkok, expects to enrol 150 patients (75 pediatric/75 adult) and to complete enrolment by the end of May 2009. Fetal Globin Induction in Beta Thalassemia: Potential and Pitfalls from Prior Trials - A Model for a Global Health Initiative Susan Perrine, MD, Hemoglobinopathy Thalassemia Unit, Boston University School of Medicine reviewed her clinical trial experience with hemoglobin-switching agents. The hemoglobin switching field was founded decades ago for the sole purpose of defining the molecular and cellular mechanisms of fetal globin gene reactivation, with the goal of developing therapeutics to reverse the natural silencing of the gene as a natural remedy for the beta globin diseases. Fetal globin gene induction as a therapeutic modality is particularly appealing because: - It is endogenous in all living humans. - Continued expression is safe. - Adequate expression is effective (thalassemia trait). - It is integrated in hematopoietic stem cells. Although there are challenges to reactivating the endogenous fetal globin genes to therapeutic levels in the diverse thalassemias, the necessary target level has been accurately identified to induce ? globin expression enough for non-? globin chains to balance ? globin chain synthesis by 65-70 percent (thalassemia trait ratios). The proof of concept in reducing anemia and eliminating long-term transfusion dependency in thalassemia has been established with three classes of therapeutic candidates. These classes of therapeutics have produced significant hematologic responses with rises in total hemoglobin (of 1-5 gms/dl) in the thalassemias: - Chemotherapeutic (cytotoxic) agents ? 5 azacytidine, hydoxyurea - Short chain fatty acids (butyrate, phenylbutyrate, and isobutyramide) - Erythropoietin (EPO) and darbopoietin The agents have corrected the phenotypes from thalassemia major, intermedia, and trait. Synergistic activity has been found when combining two groups of therapeutics: 5 azacytidine (demethylating agent) with butyrate, and butyrate with EPO. Therapeutic agents are needed that are more feasible for widespread, global application?oral agents that act at lower doses and are patient friendly, ideally have dual actions of improving red blood cell survival, not reducing red blood cell proliferation, and are safe for long term use (not cytotoxic or mutagenic). One agent, HQK -1001, which was developed entirely with NIH funding, has begun clinical testing in Thailand and Lebanon for beta thalassemia and in the U.S. for sickle cell disease, supported by the biotechnology company HemaQuest Pharmaceuticals, Inc. Factors that influence responses in to Hb F induction and require attention in clinical trial design include: baseline Hb F levels, baseline EPO levels, splenectomy status, and iron supplements. Other factors that affect responses include genetic modifiers and metabolism differences. Cooley's Anemia Foundation Thai government-made oral chelator, deferiprone Hematopoietic stem cell Deferiprone, manufactured by Lipomed AG, Switzerland Messenger ribonucleic acid National Heart, Lung, and Blood Institute National Institute of Diabetes and Digestive and Kidney Diseases Non-transferrin bound plasma iron Single nucleotide polymorphism A magnetic resonance imaging technique used to quantify tissue iron concentration in the heart and liver Thalassemia Clinical Research Network Thalassemia Longitudinal Cohort Study

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https://www.nhlbi.nih.gov/events/2009/thalassemia-workshop

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|Year : 2017 | Volume | Issue : 51 | Page : 489-498 Chalepin: A compound from Ruta angustifolia L. pers exhibits cell cycle arrest at S phase, suppresses nuclear factor-kappa B (NF-κB) pathway, signal transducer and activation of transcription 3 (STAT3) phosphorylation and extrinsic apoptotic pathway in non-small cell lung cancer carcinoma (A549) Jaime Stella Moses Richardson, Norhaniza Aminudin, Sri Nurestri Abd Malek Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia |Date of Submission||16-Jan-2017| |Date of Acceptance||22-Feb-2017| |Date of Web Publication||11-Oct-2017| Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur 50603 Source of Support: None, Conflict of Interest: None | Abstract|| | Background: Plants have been a major source of inspiration in developing novel drug compounds in the treatment of various diseases that afflict human beings worldwide. Ruta angustifolia L. Pers known locally as Garuda has been conventionally used for various medicinal purposes such as in the treatment of cancer. Objective: A dihydrofuranocoumarin named chalepin, which was isolated from the chloroform extract of the plant, was tested on its ability to inhibit molecular pathways of human lung carcinoma (A549) cells. Materials and Methods: Cell cycle analysis and caspase 8 activation were conducted using a flow cytometer, and protein expressions in molecular pathways were determined using Western blot technique. Results: Cell cycle analysis showed that cell cycle was arrested at the S phase. Further studies using Western blotting technique showed that cell cycle-related proteins such as cyclins, cyclin-dependent kinases (CDKs), and inhibitors of CDKs correspond to a cell cycle arrest at the S phase. Chalepin also showed inhibition in the expression of inhibitors of apoptosis proteins. Nuclear factor-kappa B (NF-κB) pathway, signal transducer and activation of transcription 3 (STAT-3), cyclooxygenase-2, and c-myc were also downregulated upon treatment with chalepin. Chalepin was found to induce extrinsic apoptotic pathway. Death receptors 4 and 5 showed a dramatic upregulation at 24 h. Analysis of activation of caspase 8 with the flow cytometer showed an increase in activity in a dose- and time-dependent manner. Activation of caspase 8 induced cleavage of BH3-interacting domain death agonist, which initiated a mitochondrial-dependent or -independent apoptosis. Conclusion: Chalepin causes S phase cell cycle arrest, NF-κB pathway inhibition, and STAT-3 inhibition, induces extrinsic apoptotic pathway, and could be an excellent chemotherapeutic agent. Abbreviations used: °C: Degree Celsius, ANOVA: Analysis of variance, ATCC: American Type Culture Collection, BCL-2: B-Cell CLL/Lymphoma 2, Bcl-xL: B-cell lymphoma extra-large, BH3: Bcl-2 homology 3, BID: BH3-interacting domain death agonist, BIR: Baculovirus inhibitor of apoptosis protein repeat, Caspases: Cysteinyl aspartate-specific proteases, CDK: Cyclin-dependent kinase, CO2: Carbon dioxide, CST: Cell signaling technologies, DISC: Death-inducing signaling complex, DMSO: Dimethyl sulfoxide, DNA: Deoxyribonucleic acid, DR4: Death receptor 4, DR5: Death receptor 5, E1a: Adenovirus early region 1A, ECL: Enhanced chemiluminescence, EDTA: Ethylenediaminetetraacetic acid, ELISA: Enzyme-linked immunosorbent assay, etc.: Etcetera, FADD: Fas-associated protein with death domain, FBS: Fetal bovine serum, FITC: Fluorescein isothiocyanate, G1: Gap 1, G2: Gap 2, HPLC: High-performance liquid chromatography, HRP: Horseradish peroxidase, IAPs: Inhibitor of apoptosis proteins, IC50: Inhibitory concentration at half maximal inhibitory, IKK-α : Inhibitor of nuclear factor kappa-B kinase subunit alpha, IKK-β : Inhibitor of nuclear factor kappa-B kinase subunit beta, IKK-γ : Inhibitor of nuclear factor kappa-B kinase subunit gamma, IKK: IκB kinase, IκBα : Nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor, alpha, m: Meter, M: Mitotic, mm: Millimeter, mRNA: Messenger ribonucleic acid, NaCl: Sodium chloride, NaVO4: Sodium orthovanadate, NEMO: NF-Kappa-B essential modulator, NF-κB: Nuclear factor kappa-light chain-enhancer of activated B cells, NSCLC: Nonsmall cell lung carcinoma, PBS: Phosphate buffered saline, PGE2: Prostaglandin E2, PI: Propidium iodide, PMSF: Phenylmethylsulfonyl fluoride, pRB: Phosphorylated retinoblastoma, R. angustifolia: Ruta angustifolia L. Pers, Rb: Retinoblastoma, rpm: Rotation per minute, RPMI: Roswell Park Memorial Institute, S phase: Synthesis phase, SD: Standard deviation, SDS-PAGE: Sodium dodecyl sulfate-polyacrylamide gel electrophoresis, Smac: Second mitochondria-derived activator of caspase, SPSS: Statistical Package for the Social Sciences, STAT3: Signal transducer and activation of transcription 3, tBID: Truncated BID, TNF: Tumor necrosis factor, TRADD: Tumor necrosis factor receptor type-1 associated death domain, TRAIL: TNF-related apoptosis-inducing ligand, USA: United States of America, v/v: Volume over volume. Keywords: Apoptosis, cell cycle, chalepin, nuclear factor kappa-light-chain-enhancer of activated B cells, Ruta angustifolia L. Pers, signal transducer and activation of transcription 3 |How to cite this article:| Richardson JS, Aminudin N, Abd Malek SN. Chalepin: A compound from Ruta angustifolia L. pers exhibits cell cycle arrest at S phase, suppresses nuclear factor-kappa B (NF-κB) pathway, signal transducer and activation of transcription 3 (STAT3) phosphorylation and extrinsic apoptotic pathway in non-small cell lung cancer carcinoma (A549). Phcog Mag 2017;13, Suppl S3:489-98 |How to cite this URL:| Richardson JS, Aminudin N, Abd Malek SN. Chalepin: A compound from Ruta angustifolia L. pers exhibits cell cycle arrest at S phase, suppresses nuclear factor-kappa B (NF-κB) pathway, signal transducer and activation of transcription 3 (STAT3) phosphorylation and extrinsic apoptotic pathway in non-small cell lung cancer carcinoma (A549). Phcog Mag [serial online] 2017 [cited 2022 May 26];13, Suppl S3:489-98. Available from: http://www.phcog.com/text.asp?2017/13/51/489/216356 - This study reports the capacity of an isolated bioactive compound known as chalepin to suppress the nuclear factor kappa-light-chain-enhancer of activated B cells pathway, signal transducer and activation of transcription 3, and extrinsic apoptotic pathway and also its ability to arrest cell cycle in S phase. This compound was from the leaves of Ruta angustifolia L. Pers. It provides new insight on the ability of this plant in suppressing certain cancers, especially the nonsmall cell lung carcinoma according to this study. | Introduction|| | Lung cancer is a primary malignant tumor killer worldwide. Although the main cause of lung cancer was found to be from carcinogens of tobacco smoke and environment, the mechanism of lung carcinogenesis remains unclear. The major cancer killer worldwide in both sexes is nonsmall cell lung cancer (NSCLC), accounting for >1.2 million deaths each year. The standard therapies that are available currently rarely cure the disease, and the overall 5-year survival rate is only 15% because NSCLC is usually a systemic disease at the time of appearance. In Malaysia, lung cancer is the third most common cancer with 2100 Malaysians diagnosed each year (National Cancer Society Malaysia, 2015). Plants have been a main source of medicinal compound around the world. Over 60% of cancer therapeutics that are available in the market or at preclinical trial stage are from natural products. Taxol from the Pacific yew tree, vinblastine and vincristine from the Madagascar periwinkle, aspirin from the willow tree, digitalis from foxglove, and artemisinin from wormwood are some of the prominent examples. Natural products from terrestrial and aquatic sources continue to serve as the foundations, from which synthetic compounds could be derived. Ruta angustifolia L. Pers belonging to the largest families of plant kingdom Rutaceae is a variant of the common rue and it shares the same scientific name with the common rue, Ruta angustifolia var. angustifolia. These plants are commonly used as traditional medicine. R. angustifolia is frequently known as Sadal or Garuda in Malaysia, Godong minggu or Inggu in Indonesia, and Luru in Vietnam. However, it is originated from the Mediterranean region. R. angustifolia has been conventionally used for various medicinal and culinary purposes. It was initially introduced in India and later to Southeast Asia. It is commonly cultivated as potted plants in Malaysia. It is also common in the Indian community in Malaysia to tie it on newborn's hands to avoid insect bites due to its strong smell. It can grow up to 1.5 m in height and has woody stems. It normally grows in mountainous area with a height of 1000 m above sea level. The leaves are compound and light green in color with a width of 2–6 mm and a length of 8–20 mm. The fruits are small and oval in shape, while the seeds are small, black-colored and are in a kidney shape. Its essential oil is commonly used for the manufacturing of perfume and cosmetics. Defects in apoptosis are an important factor in progression of cancer apart from role that is played by the proto-oncogenes in activating cancer cell proliferation. Many deregulated oncoproteins that drive cell division also trigger apoptosis (e.g. Myc, E1a, and Cyclin-D1). Mutations generally happen in proto-oncogenes, which would promote tumor cell growth when mutated, and at tumor suppressor genes, which could hinder the inhibition of cell cycle progression and thus encouraging abnormal cell growth. Disruption in cell cycle control mechanism can be resulted from environmental insults, which causes DNA damage. Cell cycle checkpoints control cell growth and development and regulate the intricate network of interaction. Mutations occurring at these checkpoints were found to be present in all types of cancer. Nuclear factor-kappa B (NF-κB) is a common transcription factor. Inflammatory stimuli that are normally environmental pollutants, pro-oxidants, carcinogens, stress, and growth factors usually activate the response of translocation of this transcription factor from cytoplasm to the nucleus. In the nucleus, it would bind to the DNA and initiates the gene transcription. This activation was found to be resulting in the production of various gene products that regulates important mechanisms such as apoptosis, angiogenesis, metastasis, invasion, and inflammation. R. angustifolia contains a number of bioactive compounds, which has high potential for use in the treatment of various diseases. Some of the constituents of R. angustifolia include arborinine, graveoline, psoralen, bergapten, chalepensin, chalepin, kokusaginine, moskachan (A, B, C, and D), rutamarin, and neophytadiene. Among these compounds, arborinine was reported to exhibit anticancer activity by showing cytotoxicity against A549 lung carcinoma, HeLa cervical carcinoma, KB nasopharyngeal cancer cells, MCF7 breast cancer cells, and A431 skin cancer cells.,, Arborinine inhibited the proliferation and induced apoptosis on splenocytes and thymocytes when stimulated with different mitogens. Bergapten, also known as 5-methoxypsoralen, is a compound which is prevalent in R. angustifolia was commonly used to treat various skin ailments such as psoriasis, vitiligo, and multiple sclerosis due to its capacity to intercalate and photo-crosslink DNA., The ability of bergapten to halt the proliferation of bladder and melanoma cancer cells and interrupting DNA synthesis in Ehrlich ascites tumor cells was also discovered., Graveoline exhibited antibacterial, antitumor, and spasmolytic properties. It was also found to induce apoptosis and autophagy.,, Kokusaginine which is one of the compounds present in R. angustifolia was reported to possess antimalarial and antifungal activities., It was also found to exhibit inhibitory activity against Schistosoma mansoni miracidia which may lead to schistosomiasis, which is a tropical disease in Africa. Recently, there was a report which showed kokusaginine's potential as a good inhibitor against hepatitis C virus. It was also reported to possess cytotoxicity against A2780 ovarian carcinoma cells, HeLa cervical cancer cells, and KB nasopharyngeal cancer cells., Moskachan D, isolated from R. angustifolia, was reported to have good inhibition against human lung carcinoma cells. Graveoline which is the most abundantly available compound in R. angustifolia exhibited antibacterial, antitumor, antifungal, and spasmolytic properties., Graveoline also induced cell death through apoptosis and autophagy in A375 skin melanoma cells. Drugs which have apoptotic and autophagic properties are effective for the treatment of cancer. Neophytadiene, which was also a compound found and isolated from R. angustifolia, was reported to have antipyretic, analgesic, anti-inflammatory, antimicrobial, and antioxidant activity. Rutamarin, a compound reported in R. angustifolia, was discovered to possess cytotoxicity against lung, colon, breast, and liver carcinomas. This shows that rutamarin has potential as a chemotherapeutic agent. Another study has also shown the potential of rutamarin in glucose homeostasis and improving insulin sensitivity in mice. Rutamarin was found to be having potential to treat Type 2 diabetes. Methoxsalen was also used in the treatment of vitiligo as it could assist in repigmentation of the skin with the help of sunlight. Chalepensin showed cytotoxicity against colon (HT29), lung (A549), breast (MCF7), kidney (A498), and pancreatic (PACA-2) cancer cell lines., This shows that it could be a potential chemotherapeutic agent. Another recent report showed that chalepensin has antimicrobial effect against Streptococcus mutans, a microbe which causes dental caries. Chalepin [Figure 1], a dihydrofuranocoumarin, is one of the bioactive compounds isolated from R. angustifolia. Previous studies have revealed that chalepin possesses anticoagulative potential and is able to induce necrotic cell death on hepatic cells; besides that, chalepin was found to inhibit mitochondrial respiration in rat liver mitochondria. A study in 2014 revealed that chalepin isolated from the leaves of R. angustifolia has the potential to inhibit hepatitis C virus replication. It was also reported that chalepin stimulated insulin release in rat insulinoma cell line and mild antimicrobial activity. Chalepin was also found to exhibit good cytotoxicity against Huh7.5 hepatoma cell line. Another recent study revealed that chalepin possesses excellent cytotoxicity with an IC50 value of 8.69 ± 2.43 μg/ml (27.64 μM) and induced apoptosis toward human lung carcinoma (A549) cells. This has initiated further investigation to gain further insight on the underlying mechanisms responsible for the induction of apoptotic cell death in cancer cells. | Materials and Methods|| | Cell culture, compounds, and reagents Human lung carcinoma (A549) was purchased from American Type Culture Collection (ATCC, USA). It was cultured in Roswell Park Memorial Institute (RPMI) media supplemented with 10% heat-inactivated fetal bovine serum (FBS), 1% penicillin/streptomycin (100 μg/ml), and 1% amphotericin B (100 μg/ml). The cells were maintained in a humidified incubator (5% CO2 in air at temperature of 37°C). Chalepin was isolated from the leaves of R. angustifolia using a high-performance liquid chromatography as previously described. It was dissolved in dimethyl sulfoxide (DMSO) for further analyses. Antibodies and chemicals Antibodies used in this research were primary antibodies monoclonal cyclin D1, monoclonal cyclin E1, monoclonal cyclin-dependent kinases (CDK2), monoclonal CDK4, monoclonal p21, polyclonal p21, polyclonal CIAP1, monoclonal CIAP2, monoclonal Mcl-1, monoclonal cyclooxygenase-2 (COX-2), monoclonal c-myc, monoclonal p65, monoclonal phosphorylated p65, polyclonal IKβα, polyclonal phosphorylated Ikβα, polyclonal inhibitor of nuclear factor kappa-B kinase subunit alpha (IKK-α), polyclonal IKK-β, polyclonal signal transducer and activation of transcription 3 (STAT-3), polyclonal phosphorylated STAT-3 (pSTAT-3), monoclonal death receptor 4 (DR4), polyclonal DR5, polyclonal Bid, monoclonal retinoblastoma (Rb), and polyclonal phosphorylated Rb (pRb). which were all purchased from cell signaling technologies. Bradford reagent used for protein estimation was purchased from Bio-Rad. The human cell line A549 (lung cancer) was cultured as monolayer in RPMI 1640 growth media. The cell was purchased from the American Tissue Culture Collection (ATCC, USA). All the media were supplemented with 10% v/v FBS, 100 μg/mL penicillin/streptomycin, and 50 μg/mL amphotericin B. The cells were cultured in a 5% CO2 incubator at 37°C. Cell cycle analysis After 48 and 72 h of treatments with chalepin, adherent and floating cells were collected, centrifuged, and fixed in 70% ethanol overnight. All samples were centrifuged to remove ethanol, and the cell pellets were washed with cold phosphate-buffered saline (PBS). The cells were subsequently resuspended in 300 μL of staining solution containing concentrations of 50 μg/mL propidium iodide, 50 μg/mL RNase, 0.1% Triton X-100, 1 mg/mL sodium citrate, and distilled water. Following 30 min incubation at room temperature, the cells were analyzed with a flow cytometer and data analysis was performed by Modfit LT software (Verity Software House, US). Caspases play an important role in cell death. Caspase activity assays were performed according to the instructions in the manual of the Caspases-8 Staining Kit (CaspILLUME). Cells were seeded at a density of 1 × 106 cells per culture dish (60 mm). After being subjected to treatment of chalepin at various concentrations (18 μg/ml [57.3 μM], 27 μg/ml [86.0 μM], 36 μg/ml [114.6 μM], and 45 μg/ml [143.3 μM]) for 48 and 72 h, the cells were detached using accutase, washed, and resuspended in PBS. Next, 300 μL of each sample was aliquoted into centrifuge tubes after which 1 μL of fluorescent substrate (FITC-IETD-FMK) was added to each tube and incubated for 1 h at 37°C incubator and 5% CO2. At the end of the incubation period, the cells were centrifuged at 3000 rpm for 5 min and the supernatant was removed. After that, the cells were resuspended in 0.5 mL wash buffer and centrifuged at 3000 rpm for 5 min. This step was repeated before performing the analysis with flow cytometer (Accuri C6) and a minimum of 10,000 events were acquired for each replicate. Untreated cells in 0.5% DMSO served as the control. Western blot analysis For this analysis, 1 × 106 of A549 cells were plated per tissue culture dish. Chalepin-treated whole-cell extracts were lysed in lysis buffer (20 mM Tris (pH 7.4), 250 mM natrium chloride, 2 mM ethylenediaminetetraacetic acid (pH 8.0), 0.1% Triton X-100, 0.01 mg/ml aprotinin, 0.005 mg/ml leupeptin, 0.4 mM phenylmethylsulfonyl fluoride, and 4 mM sodium orthovanadate). Lysates were then spun at 15,000 rpm for 10 min to remove insoluble material and resolved on a 10.0% sodium dodecyl sulfate-polyacrylamide gel electrophoresis gel. After electrophoresis, the proteins were electrotransferred to a nitrocellulose membrane, blocked with Blocking One (Nacalai Tesque, Inc.), and probed with various antibodies (1:1000) overnight at 4°C. The blot was washed, exposed to horseradish peroxidase-conjugated secondary antibodies for 1 h, and finally examined by chemiluminescence (enhanced chemiluminescence, Advansta). Preparation of nuclear and cytoplasm extract Nuclear extract and cytoplasmic fractions from A549 cells were prepared to determine the expression of proteins involved in the NF-κB pathway using kit from Active Motif. For preparation of nuclear extracts, the cells were first collected in ice-cold PBS. The cell suspension is centrifuged at 2000 × g at 4°C and pellet were resuspended in hypotonic buffer for 15 min on ice. A volume of 25 μl of detergent was added for every 100 μl of hypotonic buffer, and it was vortexed for 10 s at the highest speed. The lysate was then centrifuged at 14,000 ×g for 30 s in a microcentrifuge tube which has been precooled. The supernatant which was the cytoplasmic fraction was transferred into a prechilled microcentrifuge tube and stored in −80°C until further use. After collection of the cytoplasmic fraction, the pellet was used for the nuclear fraction collection. The nuclei were lysed using the complete lysis buffer provided in the kit, and the nuclear proteins were solubilized in detergent-free lysis buffer in the presence of the protease inhibitor cocktail. The suspension was incubated for 30 min on ice on a rocking platform set at 150 rpm. It was then vortexed for 30 s at the highest setting and next, centrifuged for 10 min at 14,000 ×g in a microcentrifuge tube which has been precooled at 4°C. The supernatant which was the nuclear fraction was transferred into another prechilled microcentrifuge tube and the aliquot was stored at −80°C until further use. All the values reported are shown as mean ± standard error of the mean, and all the experiments were conducted at least twice using sample triplicates. Figures from morphological studies, flow cytometry plots, and Western blot analyses are representative of the experiment replicates. Comparison between control and treated groups was performed using one-way analysis of variance with post hoc Tukey test (*P < 0.05 considered statistically significant). Statistical analyses were performed using SPSS 20.0 software (IBM, USA) and calculations were done using the Microsoft Excel. Quantification of the bands in the Western blot analysis was done using the ImageJ software (developed by Wayne Rasband). | Results|| | Cell cycle analysis using the flow cytometry revealed that chalepin inhibited cell cycle at the S phase. Cell cycle analysis segregates cells based on its DNA content. The DNA was stained/labeled and measured to determine the phase in which the cell is located. There was a significant accumulation of cells in the S phase after treatment of chalepin for 48 and 72 h [Figure 2]. The accumulation was 27.73% at 48 h and 25.38% at 72 h after treatment with 45 μg/ml of chalepin. For the control (untreated) cells, the number of cells at the S-phase was only about 4.02%. Accumulation of cells at a certain phase indicates that the cell cycle is arrested at that particular point. As concentration of chalepin increases, the number of cells in S phase increased. From the cell cycle analysis, it is apparent that chalepin arrests A549 cells at the S phase which is the synthesis phase where DNA replication occurs. |Figure 2: Cell cycle analysis of A549 cells treated with chalepin at 48 h and 72 h as compared to untreated control. The data expressed as mean ± standard deviation of three replicates. Asterisks indicate significantly different value from control (*P < 0.05)| Click here to view This preliminary result was further studied by determining the expression of the cell cycle-related proteins upon the treatment of chalepin [Figure 3]. |Figure 3: Chalepin induces changes expression in cell cycle-related proteins in a dose-dependent manner. A549 cells (2 × 106 mL-1) were treated with 36 μg/ml of chalepin at various time points, after which the whole-cell extracts were prepared and 30 μg of protein was resolved by 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis gel, electrotransferred onto nitrocellulose membranes, and probed for the cyclin E, cyclin D1, CDK2, CDK4, p21, p27, and phosphorylated retinoblastoma proteins. The experiments were conducted in triplicates| Click here to view The effect of chalepin on antiapoptotic proteins such as cIAP-1, cIAP-2, and MCL-1 was evaluated. Western blot results showed that the antiapoptotic gene products were downregulated with a decrease of up to 0.79-, 0.56-, and 0.59-fold for the proteins cIAP-1, cIAP-2, and MCL-1, respectively, at 24 h incubation of chalepin. Inhibitor of apoptosis proteins (IAPs) is commonly involved in the regulation of caspases and immune signaling [Figure 4]. |Figure 4: Chalepin inhibits the expression of antiapoptotic gene products, cIAP-1, cIAP-2, and MCl-1 in a dose-dependent manner. A549 cells (2 × 106 mL-1) were treated with 36 μg/ml of chalepin at various time points, after which the whole-cell extracts were prepared and 30 μg of protein was resolved by 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis gel, electrotransferred onto nitrocellulose membranes, and probed for cIAP-1, c-IAP-2, and MCl-1. The experiments were conducted in triplicates| Click here to view COX-2 was downregulated upon treatment of chalepin toward A549 cells at 24 h treatment incubation time, with a fold change of 0.56 at 24 h incubation [Figure 5]. Treatment of chalepin resulted in downregulation of c-myc at earlier time points such as 2 and 4 h with a fold change up to 0.55 at 4 h, some upregulation at 8 and 12 h, and further downregulation at 24 h incubation time (0.72-fold) [Figure 5]. |Figure 5: Chalepin inhibits the expression of cyclooxygenase-2 and c-myc in a dose-dependent manner A549 cells (2 × 106 mL-1) were treated with 36 μg/ml of chalepin at various time points, after which the whole-cell extracts were prepared and 30 μg of protein was resolved by 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis gel, electrotransferred onto nitrocellulose membranes, and probed for cyclooxygenase-2 and c-myc. The experiments were conducted in triplicates| Click here to view Our results also showed that the Iκβα phosphorylation was downregulated upon treatment of chalepin (0.62-fold at 6 h) [Figure 6]. Degradation of Iκβα however showed an inconsistent result, with upregulation (1.49-fold at 1 h) and slight downregulation (0.92-fold at 6 h) in the protein expression. The inhibition was also through modulation of the p65 subunit of NF-κB where the phosphorylation of p65 and the translocation of the p65 subunit to nucleus were inhibited. Results obtained indicated an upregulation and then a downregulation (0.57-fold) at the 6 h incubation time in the p65 subunit in the nuclear fraction. This shows that there is an inhibition in the translocation of p65 into the nucleus. Phosphorylation of p65 in the nucleus was inhibited as there was a downregulation in the expression of the phosphorylated p65 upon treatment of chalepin (0.58-fold at 6 h). Overall, the results indicate that the NF-κB pathway is suppressed, especially at earlier incubation time. |Figure 6: Chalepin suppresses nuclear factor-kappa B pathway in a time-dependent manner. A549 cells (2 × 106 mL-1) were treated with 36 μg/ml of chalepin at various time points (0, 1, 2, 4 and 6 h), after which the cell nuclear extracts were prepared and 30 μg of protein was resolved by 10% sodium dodecyl sulfate-polyacrylamide gel electrophoresis gel, electrotransferred onto nitrocellulose membranes, and probed for phosphorylated p65, p65, phosphorylated IKβα, and IKβα. The experiments were conducted in triplicates| Click here to view In our study, treatment of chalepin suppressed the pSTAT3, thus indicating an inactivation of the transcription factor [Figure 7]. The pSTAT3 was downregulated to 0.59-fold at 6 h treatment of chalepin. Chalepin therefore could inhibit the progression of A549 cells. The expression of STAT3 protein remains almost constant. |Figure 7: Chalepin inhibits constitutive signal transducer and activation of transcription 3 phosphorylation in A549 cell line in a time-dependent manner. A549 cells (2 × 106 mL-1) were treated with 36 μg/ml of chalepin at various time points, after which the whole-cell extracts were prepared and 30 μg of protein was resolved by 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis gel, electrotransferred onto nitrocellulose membranes, and probed for phosphorylated signal transducer and activation of transcription 3 and signal transducer and activation of transcription 3. The experiments were conducted in triplicates| Click here to view Caspase 8 is associated with the activation of the extrinsic apoptotic pathway. Cells with activated caspase 8 would move to the right side (V1-R) of the density plot [Figure 8]. The results show that there is a remarkable increase in the caspase 8 activity of cells treated with chalepin as compared to the control. It was observed that after 48 h of incubation, there is a 5-fold increase in the activation of caspase 9 from 4.90% ± 0.35% in untreated control to 26.10% ± 0.21% in cells treated with 45 μg/ml of chalepin. As for the 72 h incubation period, there was an increase from 6.00% ± 0.15% for untreated control cells to 51.7% ± 0.35% for treated cells with 45 μg/ml of chalepin which corresponds to an 8.61-fold increase. These results show that chalepin-treated cells undergo activation of caspase 8. |Figure 8: Caspase 8 activity of A549 cells treated with chalepin and incubated for 48 h and 72 h. (a) Flow cytometric analysis of apoptotic (V1-R) and nonapoptotic populations (V1-L) for active caspase 9 activity at 48 h incubation (b) Flow cytometric analysis of apoptotic (V1-R) and nonapoptotic populations (V1-L) for active caspase 8 activities at 72 h incubation (c) Fold increase of A549 cells treated with chalepin at different incubation times. The data expressed as mean ± standard deviation of three replicates. Asterisks indicate significantly different value from control (*P < 0.05)| Click here to view DR4 and DR5 showed an upregulation at 24 h incubation time, with fold changes of 2.17 and 2.84, respectively, upon treatment with chalepin in the Western blot study. Interestingly, there was an initial downregulation in the expression and then a significant upregulation at the 24 h incubation time [Figure 9], whereas BH3-interacting domain death agonist (BID) showed downregulation in expression and showed the most downregulation at 12 h with 0.47-fold change [Figure 10]. |Figure 9: Chalepin increases expression level of death receptors in A549 cell line in a time-dependent manner. A549 cells (2 × 106 mL-1) were treated with 36 μg/ml of chalepin at various time points, after which the whole-cell extracts were prepared and 30 μg of protein was resolved by 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis gel, electrotransferred onto nitrocellulose membranes, and probed for DR4 and DR5. The experiments were conducted in triplicates| Click here to view |Figure 10: Chalepin promotes cleavage of BH3-interacting domain death agonist in A549 cell line in a time-dependent manner. A549 cells (2 × 106 mL-1) were treated with 36 μg/ml of chalepin at various time points, after which the whole-cell extracts were prepared and 30 μg of protein was resolved by 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis gel, electrotransferred onto nitrocellulose membranes, and probed for BH3-interacting domain death agonist protein. The experiments were conducted in triplicates| Click here to view | Discussion|| | There is a strong correlation between cell cycle and cancer. Cell cycle is machinery that controls cell proliferation and cancer is a disease, which is caused by inappropriate cell proliferation. Several fiascos in the cell cycle's normal signal delivery, which tells the cell to adhere, differentiate, or die that causes the cancer cells to proliferate uncontrollably. The cell cycle comprises a series of complex molecular and biochemical signaling pathways. It has four phases, which include G1 phase, S phase, G2 phase, and M phase. There are several checkpoints that are important control points that regulate the cell cycle to proceed further or to halt and undergo apoptosis. Cells use a complex set of enzymes called kinases to control various steps in the cell cycle. CDKs are a specific family of enzymes that use signals to switch on cell cycle mechanisms. These kinases require association with a second subunit, which is the regulatory protein, known as cyclin. It is transiently expressed at the appropriate period of the cell cycle to be activated. Cyclin subunit complexes with its partner CDK to create an active complex. When functioning properly, the cell cycle regulatory proteins (cyclins) act as tumor suppressors by controlling cell growth and inducing the death of damaged cells. Genetic mutations which can lead to the absence of one or more of the regulatory proteins at the cell cycle checkpoints can result in the “molecular switch” being turned permanently on, permitting uncontrolled multiplication of the cell, leading to carcinogenesis or tumor development. Throughout the G1 phase, Rb is underphosphorylated. It is phosphorylated just before S phase and remains phosphorylated until late mitosis. Cyclin E complexes with CDK2 to regulate the G1/S phase transition, whereas cyclin D complexes with CDK4 to regulate the G1 phase. These CDK-cyclin complexes are negatively regulated by endogenous CDK inhibitors such as p21Cip and p27Kip or degradation of cyclin. CDK4/cyclin D complex, which initiates the progression of cell cycle through the G1 phase, is inhibited by p21cip1, while CDK2/cyclin E complex, which initiates the progression of cell cycle to the S-phase, is inhibited by p27Kip1. This inhibition would result in hypo-pRb proteins that would result in inhibition of E2F transcription factor into nucleus that would subsequently activate the transcription of cell cycle related genes. p21Cip1 arrests cells in both G1 and G2 cell cycle phases; p27Kip1 blocks the G1/S phase transition. The regulatory subunit, i.e., cyclin D and E, showed a downregulation, 0.52- and 0.93-fold, respectively, at 24 h, when treated with chalepin at concentration 36 μg/ml (114.6 μM). CDK2 and CDK4, which complex with cyclin E and D, respectively, showed a dramatic decrease in expression. It showed a decrease of up to 0.38-fold (24 h) and 0.50-fold (4 h), respectively. This shows that the complex formation that is required for progression of cell cycle through G1 and S phase is inhibited. This could also be the reason why there was some accumulation of cells observed in the G1 phase in the flow cytometry cell cycle analysis. The inhibitors of CDKs (p21 and p27) showed slight downregulation; however, it was upregulated (to 0.80 and 0.95, respectively) at higher incubation time. pRb protein showed hypophosphorylation. The expression of pRb showed 0.48-fold at 24 h. This is an indication that E2F gene is not activated and transcription of genes required for cell cycle progress is halted as pRb protein is essential for this downstream pathway. This result correlates with the S-phase arrest. Western blot was conducted at a time point of 2, 4, 8, 12, and 24 h for whole-cell extract-related analysis of proteins. A time point up to 24 h was chosen due to the reason that cell death (apoptosis) is initiated approximately at 24 h. The study of the expression of proteins when cell death is occurring would result in inaccurate results. The time point where cell death initiates was studied using the trypan blue dye exclusion assay. The results show that at 24 h, about 91.17% ± 1.53% of viable cells were observed. The percentage of viable cells dropped sharply to 39.67% ± 1.89% at 48 h and to 12.0% ± 1.57% at 72 h. Hence, the time point of up to 24 h has been selected for the study of the protein expression. IAPs are highly conserved in viruses and mammals and are also known as Baculovirus IAP Repeat (BIR) domain-containing proteins that are a class of protein characterized by the presence of BIR domain. IAPs are Zn 2+ ion coordinating protein–protein interaction domain. IAPs are overexpressed in a number of tumors and are known to regulate carcinogenesis at various stages. c-IAP1 and c-IAP2 have been suggested as proto-oncogenes by various genetic studies. c-IAP1 and c-IAP2 bind and inhibit caspase 3 and 7. Rudimental cancer cells fail to respond to treatment because the malignant cells fail to respond to chemotherapy, radiation, or the immune surveillance by endogenous cytotoxic T-cells and natural killer cells. The failure of cell death results from failure of the cells to undergo apoptosis and initiate caspase activation. IAPs, which are the antiapoptotic proteins, play a role in blocking cell death, by inhibiting the downstream caspase activation pathways. When c-IAP1 and c-IAP2 are absent in the death receptor complex, the binding of death ligands to their receptors leads to the formation of the death-inducing signaling complex, in which adaptor proteins (Fas-associated death domain [FADD] and/or tumor necrosis factor [TNF] receptor type-1 associated death domain) bind with their death domain and induce the recruitment and activation of the initiator caspases, caspase-8 or -10. A new therapeutic approach is to develop small molecule drugs that mimic second mitochondria-derived activator of caspase (Smac), a pro-apoptotic mitochondrial protein that inhibits IAPs. Smac mimetics also known as the IAP antagonists suppresses IAPs to induce cancer cell death. The unique action of Smac mimetics could enhance therapeutic activity of many existing cancer therapies. In our research, it is evident that treatment of chalepin on A549 cells inhibits the expression of c-IAP1 and c-IAP2, 0.79- and 0.56-fold, respectively [Figure 4]. Modulation of IAPs results in chalepin being similar to a Smac mimetic. The mode of action for commonly available drugs for the treatment of NSCLC such as doxorubicin, erlotinib, gemcitabine, paclitaxel, and vinorelbine is through its ability to act as a Smac mimetic. Ability of chalepin to also act as a Smac mimetic is an interesting observation, which may promise a solution in the treatment of lung cancer. The antiapoptotic protein MCL-1 functions as a key regulator of cancer cell survival and a known resistance factor for small molecule B-cell CLL/lymphoma (BCL-2) family inhibitors making it an attractive therapeutic target. However, to directly inhibit MCL-1 requires the disruption of high-affinity protein–protein interactions, and therefore, designing small molecules potent enough to inhibit MCL-1 in cells has proven extremely challenging. MCL-1 has been proven to mediate multiple types of tumor. MCL-1 gene locus was amplified in a variety of tumor types including NSCLC. A549 cells treated with chalepin showed downregulation in the expression of MCL-1 protein with the protein suppression of up to 0.59-fold [Figure 4]. This result indicates that chalepin might be able to act as MCL-1-specific BH3 mimetics. Members of the BCL-2 family such as BCL-2, BCL-XL, and MCL-1 are antiapoptotic proteins and are overexpressed in many cancers. These proteins act to bind and sequester proapoptotic proteins such as Bax and Bak. Targeting the BCL-2 family proteins promises a good chemotherapeutic passage. Small molecules that have the capacity to mimic the BH3 domain of BH3-only BCL-2 family members could serve as inhibitor. BH3 mimetics are generally short peptides or organic molecules. The latter are indeed antagonists of the prosurvival members. MCL-1 inhibition was found to cause tumor regression and cell death in various experiments. MCL-1 inhibition could be executed through various approaches such as indirect CDK inhibitors, small molecules, and BH3 peptides, which could directly bind to MCL-1 to antagonize its activity. However, BH3 mimetics are considered to be the best type of MCL-1 inhibitor. High binding affinity is difficult to achieve, which may be due to the nature of the protein/protein interaction and the conformational rigidity of the hydrophobic binding groove of MCL-1. To determine the mode of action of chalepin in inhibition of MCL-1, further studies need to be conducted. COX-2 is formed by a cell in response to the presence of its substrate and not usually expressed in normal tissue. COX-2 is overexpressed in neoplasms and premalignant lesions. Inhibitors of COX-2 have been investigated as chemotherapeutic agents for chemoprevention. Preclinical data suggest that inhibitors of COX-2 may have the tendency to protect against colon, breast, lung, esophageal, and oral tumors. COX-2 overexpression is often associated with an increased production of prostaglandin E2 (PGE2) which is a major by-product of COX-2 that is involved in cell death, cell proliferation, and tumor invasion in many types of cancer. PGE2 affects through membrane receptors such as EP1, EP2, EP3, and EP4, which activates different types of signaling pathways. NSCLC is associated with Ras mutation, which leads to upregulation of COX-2 that result in increased PGE2 production. PGE2 increases cell proliferation in A549 cell line and this activation is associated with activation of Ras pathway through EP4 receptor. PGE2 acts by affecting the release of amphiregulin, which is the most abundant ligand in A549 cells. Several signaling pathways are associated with tumor progression, which is linked to PGE2, and this is why inhibition of COX-2 is a good strategy in fighting cancer. In our study, COX-2 was downregulated upon treatment of chalepin toward A549 cells at 24 h treatment time (0.56-fold) [Figure 5]. However, the study on the expression of the protein after 24 h was not undertaken as the cells starts to undergo cell death after 24 h, according to the trypan blue dye exclusion assay results. This indicates that chalepin could inhibit the production of PGE2 and activation of Ras pathway thus inhibiting cell proliferation. c-Myc is an oncogene which regulates cellular growth and metabolism. In cancer cells, metabolic changes need to take place to support the increased demand of nucleic acids, lipids, and proteins that are necessary for rapid cellular proliferation. In these situations, c-myc is often overexpressed. The c-myc gene was amplified in many human cancers, including breast cancer, lung cancer, and colon cancer. According to a study, c-myc was found to induce metastasis in NSCLC. In our study, treatment of chalepin resulted in downregulation of c-myc at earlier time points such as 2 and 4 h (0.55-fold change). There was an increase in the expression at 8 and 12 h and a decrease in the expression at 24 h (0.72 fold) [Figure 5]. The study of the expression later than 24 h was not done due to the reason where the cell death commences after the 24 h time point. Since there was a inconsistency in the expression of c-myc, this particular gene product, which is responsible for cellular growth and metabolism, could be inhibited by chalepin. As c-myc was found to promote metastasis in A549 cells, chalepin could be an agent that inhibits metastasis. NF-κB is an omnipresent transcription factor. It consists of a few subunits such as p50, p65, and Iκβα, which reside in the cytoplasm. When there are external stimuli such as inflammation, environmental pollutions, prooxidants, carcinogens, stress, and growth factors, these subunits are activated. External stimuli generally activate the IKK complex. There are a few kinases, which assist in this activation, which is known as IKK. The regulatory step in this pathway requires activation of IKK complex that has high molecular weight. The catalysis of IKK is generally carried out by three tightly associated IKK subunits. IKK-α and IKK-β serve as the catalytic subunits of the kinase. IKK-γ or commonly known as NEMO serves as the regulatory subunit. The activation of IKK initiates upon phosphorylation at Ser177 and Ser181 in the activation loop of IKK-β (Ser176 and Ser180 in IKK-α), which causes conformational changes, resulting in kinase activation. The increase in the activity of kinase will result in the phosphorylation of the NF-κB inhibitor, which is Iκβα that would result in dissociation of the inhibitor from NF-κB and ubiquitination of the Iκβα. The ubiquitination would then recruit proteasome, which would degrade the Iκβα, an inhibitor. Serine phosphorylation at various sites of the p65 subunit has been shown to be important in initiating transcription. The free NF-κB would then move to nucleus to initiate transcription of DNA to mRNA and then further translate to proteins which would subsequently respond to the initial external stimuli by causing changes in the cell. This activation has been known to affect various gene products, which regulates inflammation, cancer, angiogenesis, metastasis, apoptosis, and chemoresistance. Chalepin was found to suppress the NF-κB activation, which is commonly induced by various carcinogens and inflammatory agents. In this study, chalepin was found to act through direct interaction with the p65 subunit of NF-κB pathway and also through its ability to inhibit phosphorylation of the inhibitor of NF-κB, i.e., Iκβα, thus causes the pathway to be in an inactive state. The pathway was inhibited through suppression of Iκβα phosphorylation and degradation. Signal transducer and activator of transcription 3 or STAT3 is overexpressed in many human tumors. The STAT3 family of transcription factor controls various physiological processes such as immunity, metabolism, development, and differentiation. STAT3 is often abnormally expressed in cancer. STAT3 has been a promising target for the development of novel cancer drugs. Several studies have shown that modulation of constitutive STAT3 has a critical role in the tumor progression. pSTAT3 contributes to an important role in cell proliferation and survival of tumor cells in various types of cancer including head and neck cancer, multiple myeloma, lymphomas, and leukemia. Treatment of chalepin suppressed the pSTAT3 (0.59-fold change) thus indicating an inactivation of the transcription factor [Figure 7]. Chalepin therefore could inhibit the progression of A549 cells. Chalepin is a good candidate for the modulation of STAT3. However, further research needs to be conducted. Chalepin was found to be able to suppress expression of several STAT3 regulated genes such as cyclin D1 which is responsible for cell proliferation, several antiapoptotic genes such as Mcl-1 and c-Myc, immune suppression, and inflammation-related genes, e.g., COX-2 and p21, which is associated with cell survival and metastasis. With this results, it is noteworthy that chalepin is not specific to NF-κB pathway as it can also affect pSTAT3. Hence, it is a multitargeted agent that can be used against various malignancies as well. Apoptosis can be initiated through two major interconnected pathways. The first one involves the activation of the TNF family of death receptors, also known as extrinsic pathway. The second involves the release of cytochrome c from mitochondria, also known as intrinsic apoptosis pathway. Caspase 8 exists in an inactive proenzyme form and is converted to the active form upon recruitment to the cytoplasmic domain of death receptors. TNF-related apoptosis-inducing ligand or commonly known as TRAIL, when binding with DR4 or DR5, results in the recruitment of an adaptor protein FADD. The activated caspase 8 initiates apoptosis through two different mechanisms: (i) directly activates caspase 3 to stimulate apoptosis and (ii) by cleaving BID, i.e., the BH3-interacting death domain which acts as a precursor in activating the intrinsic apoptosis pathway. DR4 and DR5 showed an upregulation at 24 h incubation time upon treatment with chalepin. The upregulation was 2.17-fold and 2.84-fold change for DR4 and DR5, respectively. Interestingly, there was an initial downregulation in the expression and then a significant upregulation at the 24 h incubation time [Figure 9]. Activation of caspase 8, which was observed through flow cytometry analysis [Figure 8], further confirms that the extrinsic pathway is activated upon treatment of chalepin. Caspase 8 could activate mitochondrial apoptosis pathway/intrinsic apoptosis pathway, which is mediated by caspase 8 substrate BID. Caspase 8 cleaves BID to truncated BID (tBID) and it translocates to the mitochondria to interact with members of the Bcl-2 family to promote cytochrome c release. Release of cytochrome c would then activate caspase 9 and then caspase 3 to initiate apoptosis. Western blot analysis showed the downregulation of the protein BID, 0.69-fold change at 24 h [Figure 10]. This indicated the cleavage of BID to tBID which would initiate mitochondria to release cytochrome c and activate apoptosis through the mitochondrial pathway. A recent report showed that chalepin activated caspase 9 and caspase 3 which confirmed the occurrence of the downstream intrinsic apoptosis pathway. If we were to analyze the mechanism of action of chalepin as a whole, we can conclude that chalepin targets multiple pathways which are involved in tumorigenesis. Chalepin can be described as possessing various mechanism of action. Chalepin has been predominantly found to cause cell death A549 human lung carcinoma through the intrinsic apoptotic pathway from a previous report. Our study further confirms that chalepin not only acts through the intrinsic apoptotic pathway, and it also inhibits the death receptor-induced apoptotic pathway. Chalepin also acts as to inhibit the pSTAT3 which is essential for the activation of transcription in cell. This makes chalepin as a potentially effective suppressor of tumor cell survival, angiogenesis, and proliferation. In addition, chalepin showed suppression toward the NF-κB pathway via inhibition in the phosphorylated Iκβα and degradation of Iκβα. To add to this, chalepin also inhibited the phosphorylation of p65 and translocation of this protein to the nucleus to initiate transcription. Chalepin also downregulated the expression of NF-κB regulated antiapoptotic (c-IAP1, c-IAP2, XIAP, survivin, Bcl-2, and Bcl-xL) and proliferative (cyclin D1, cyclin E, COX-2, and c-myc) gene products. These results suggest that chalepin may be assisted by NF-κB pathway to play its role in causing cell death. Medicinal plants have important role in large group of the world's population. Currently, the recognition and development of medicinal plants are on increase in developing nations as well as industrialized nations. Asian and African countries particularly have infused herbal medicine into their primary healthcare. It remains as an important element in their medicinal systems. There is an estimation that medicines derived from plant constituents contribute to 25% of the total modern medicinal drugs.R. angustifolia which has been well documented for its ethnopharmacological property, especially in Asian region, proves to possess valuable medicinal property, especially its chemical constituent, chalepin, which was proven by this scientific research to possess chemotherapeutic property which is beneficial in combating cancer. | Conclusion|| | This is the first report on the effect of chalepin isolated from R. angustifolia L. Pers against A549 cell line on the mechanistic pathway of cell death and modulation in the cell cycle of A549 cells. Cell cycle arrest was found to occur at the S phase with downregulation in cyclin D, cyclin E, CDK2, and CDK4 and also with slight upregulation in the inhibitors of CDKs, i.e., p21 and p27. A downregulation was observed in the pRb protein. Chalepin showed suppression of the NF-κB pathway with downregulation in the pIκβα and Iκβα degradation and inhibition in the phosphorylation and translocation of the p65 protein subunit. Besides that, extrinsic apoptosis pathway was triggered upon treatment of chalepin on the A549 cells. Caspase 8, which is a key initiator kinase in the extrinsic apoptosis pathway, was activated upon treatment of chalepin. Besides that, DR4 and DR5 were upregulated and BID cleavage further strengthened the activation of the extrinsic apoptosis pathway by chalepin. pSTAT3 was inhibited upon introduction of chalepin. Chalepin was found to inhibit several STAT3-regulated genes such as c-myc, COX-2, Mcl-1, proteins. STAT3 and pSTAT3 were also downregulated. c-IAP1 and c-IAP2, which are antiapoptotic proteins, were found to be downregulated after treatment of chalepin. It can therefore be concluded that chalepin induces apoptosis and suppresses pSTAT3, NF-κB pathway, and extrinsic apoptosis pathway through BID cleavage. This compound could be an excellent candidate to be considered as a chemotherapeutic agent. Jaime Stella Moses Richardson would like to acknowledge Ministry of Higher Education for providing scholarship under the MyPhD Scheme in the MyBrain15 program. We would also like to acknowledge the Ministry of Higher Education of Malaysia and the University of Malaya for financial assistance to support this study, which was received through the HIR MOHE F000002-21001 Grant and IPPP PG200/2014B Grant. We would like to acknowledge Dr. Gautam Sethi from NUS, Singapore, for giving his valuable comments on this work. Financial support and sponsorship We would also like to acknowledge the Ministry of Higher Education of Malaysia and the University of Malaya for financial assistance to support this study, which was received through the HIR MOHE F000002-21001 Grant and IPPP PG200/2014B Grant. Conflicts of interest There are no conflicts of interest. | References|| | Chen W, Li Z, Bai L, Lin Y. NF-kappaB in lung cancer, a carcinogenesis mediator and a prevention and therapy target. Front Biosci (Landmark Ed) 2011;16:1172-85. Brambilla E, Gazdar A. Pathogenesis of lung cancer signalling pathways: Roadmap for therapies. Eur Respir J 2009;33:1485-97. Fadlalla K, Watson A, Yehualaeshet T, Turner T, Samuel T. Ruta graveolens extract induces DNA damage pathways and blocks Akt activation to inhibit cancer cell proliferation and survival. Anticancer Res 2011;31:233-41. Foster I. Cancer: A cell cycle defect. Radiography 2008;14:144-9. Sethi G, Ahn KS, Aggarwal BB. 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Tuli, Katrin Sak | | ||Anti-Cancer Agents in Medicinal Chemistry. 2020; 20(15): 1797 | |[Pubmed] | [DOI]| ||Distinct expression and prognostic value of OTU domain-containing proteins in non-small-cell lung cancer | ||Jingjing Deng, Gouxin Hou, Zhixian Fang, Jialiang Liu, Xiao-Dong Lv | | ||Oncology Letters. 2019; | |[Pubmed] | [DOI]|

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2022-05-26T02:21:48Z

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Organic Pumpkin Granola (Convenient Pack) 45g Malaysia Country of Origin: Malaysia Highlight: Simply Natural’s Organic Pumpkin Granola is now available in smaller pack! Super convenient; great for those who’re always on-the-go. Made with fresh Australian pumpkin puree (>10%), it has a nice golden yellow colour with great pumpkin smell. This perfect little clusters of crispy granola with oat and nuts texture tastes slightly creamy and sweet, balanced well with tanginess from the dried fruits. High in protein and fibre keeping your tummy happy until the next mealtime. Enjoy it as a hearty breakfast, a topping, a mix-in or as a snack on its own! Selling Region: Other Regions

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https://zenxin.com.my/product/organic-pumpkin-granola-convenient-pack/

2022-05-26T01:45:05Z

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Muhammed sits sketching a stick man and then he picks up a green pencil crayon, colouring in the man he has drawn. No one has bothered to ask these children about what they witnessed during last year’s massacre of the Rohingya in Burma. No one seems to care what children have to say. Ten or so children sit in a bamboo hut, in what is now a make-shift Rohingya village at the end of a dusty road. The village is nothing but a collection of huts and tents put up in sand. This is not where these children are originally from, they were forced here after they were chased to the water amid sword, spear and gun attacks while their homes in the Kyauk Phyu village were burnt down last year. The sun beats down; the children surround us, wanting to see the foreigners. The American doctor, (I won’t reveal her name for her protection) works with the Rohingya and pays special attention to these children. She seems like the only one that wants to hear what they have to say. They are all drawing away, boys and girls. Then they hold up their drawings and share their stories with the rest of the class. Some children look-in from outside, through the cracks in the bamboo and the plastic sheeting that covers the outside, peering in to see something and hear something that no-doubt they have heard before. But now, it is being shared in a manner that it has not been shared previously. Abdul is mute. This is his first time drawing and he is eleven. His drawings are detailed. They show death, houses burning, soldiers, monks and local Rakhine carrying weapons. All the drawings are similar; they all show things that children should not be subjected to. The children’s accounts are vivid and graphic. They all say they saw people hacked into pieces. In one drawing Hussain draws a stick man, with his heads, arms and legs separated, he says he saw someone chopped to pieces. There are bodies in red water. “I saw dead people in the water, I saw Rakhine stab them whilst they were trying to swim.” That’s why the colour of the water is red. All of the children are still scared, they have been dispelled with deadly force out of their village, and their homes burnt to the ground, all of them told me that they suffer from nightmares. Even in their sleep they cannot escape the horror of what took place. Of how the military, monks and civilians slaughtered Rohingya and drove them out, now forced to live in IDP camps, cut off from the rest of the world. They are not allowed to leave the area. The Rakhine on the other hand have no such restrictions. He doesn’t smile. Sharp face and defined features, his eyes are striking, they are painful to look into, wise beyond their years and have seen things that no human being should have to see. He explains how they ran from the sword wielding Monks. “A boat was set on fire. People jumped into the river and tried swimming. The Rakhine came on boats and stabbed people with their spears as they tried swimming away.” There was one disturbing story that a number of the children drew and explained to me. A mentally ill child, was killed, he was beheaded. “Did you see it with your own eyes?” I ask. “Yes,” they all reply. The picture that emerges after speaking to the children is that themilitary, the police, the monks and Rakhines were involved in the massacre last year. The doctor tells me that these children are suffering from Post Traumatic Stress disorder. One child has since saw a Rakhine man and passed out. In one village, the water buffalos were late coming back. Whilst the children were playing, someone shouted, “they’re coming!” the children began to run and scream, they thought the mobs were returning to finish them off. “These kids need a child psychiatrist,” the doctor tells me. “I’m doing what I can.” The children have coloured in the monks orange, green for the military and police, and just black for the Rakhine mobs. “The Rakhine and the mobs came first, then when some of our family defended themselves and fought back the army came in and shot them,” says Ramina. She’s 13-years-old and acts like a woman twice her age. She is clearly the one that the children look up to, mature, controlled and has a sense of authority about her. Abdul draws a bike amongst the death and destruction, he points to himself to indicate it belonged to him, and then rolls his hands forward symbolising the cycling of the feet. “Where is your bike now?” He waves his hand away, and pushes his arms back and forth like he is running; he had to leave it behind, a sullen sadness in his eyes. The doctor lets the children take one pencil crayon each, their faces light up, smiles beaming, it is the first gift they have received in a while.Their childhood has been interrupted, simply because they are Rohingya. As soon as they were conceived they were destined to be persecuted by this state that professes to be moving towards democracy whilst actively engaging in the brutality and cleansing of the Rohingya. The Rohingya are not recognised as citizens of Burma and have no rights. I suppose this fact is a mere inconvenience to World leaders and Corporation CEO’s as they compete for Burma’s natural resources. Human rights abuses are not spoken about when you have the potential to sign multi-million dollar deals. The world has remained silent at the cycle of violence. Rohingya is not just a word, they are real people, with feelings; they are children who want to draw pictures; they are people who just want to be able to live; they are the Abduls and Ramina’s just like the Billys and Janes who just want to be able to ride their bikes. A burnt property in Meiktila following attacks on Muslims,March 2013. photo by Hein Aung Following recent attacks in central Myanmar against Muslims, the displaced have been fleeing to the central city of Mandalay. Buildings were burnt down and the ‘official’ death toll stood at 32, as angry mobs roamed the streets. The reality of events is very different from what we have heard on our TV screens. Burmese state media is not the most reliable of sources and very few independent or Western journalists have reported directly from the ground. The displaced are scattered across the city, accommodated by fellow Muslims and are still very scared to return to their homes in Meiktila, a hundred miles away. I traversed through side streets to the site of one building housing the displaced. Young men stood guard, looking wary and suspect. After a long discussion we were allowed in to interview some of the refugees, they asked for their faces to be blurred out on camera. The metal gates to the building were unlocked and we were allowed in. Hafiz, a seventeen-year-old student, had been in school at the time when the violence began. His teacher told him to run, “we ran, we saw the younger children falling over, the older kids had to help them,” he said, recalling his account. “We hid, and then moved from place to place until we were rescued and brought here. I’m not sure where some of my other friends are.” He looked around to his classmates in the small open space opposite a mosque in the mainly Muslim district of Mandalay. I showed him some pictures from a local journalist; two of them were of dead teenagers. He put his hand up to the camera touching the screen, “that’s my friend,” he said. We showed him another and he struggles to speak “and this one, those are Osama and Karimullah,” he paused; his friends surrounded the camera and inspected the pictures of bodies on the ground, in unnatural poses. Hafiz’s friend. Murdered in Meiktila, March 2013. Photo by Hein Aung One body, Osama’s, has a massive gash to the back of the neck, which looks like it was caused by a machete. The other boy had a massive laceration in a similar place, both bodies had been there for three days before a local journalist, Hein Aung, took the pictures. They are too graphic to print. The class mates consoled each other, two friends lost. The pictures confirm their fears, but there are still friends unaccounted for, but we have no more pictures that can be identified, the rest are of burnt corpses. Not that that was a comfort to these young men, to anyone. Nearby, one hundred and five year old Kairunbi, laid on the floor, exhausted. Her seventy-one year-old daughter watched over her. “We had to use a stretcher to get her here,” she told me. “We will go back when it is safe to do so,” she added. “We could be here for a while.” Muslims have long been an oppressed minority in Myanmar. Last year’s massacre of the Rohingya Muslims caused outrage in the Muslim world but the Western media gave it little attention. The Rohingya are not recognised as Burmese citizens. The darling of the West Aung San Suukyi, a former political prisoner, democracy advocate, and current member of the Burmese Parliament, remained silent when asked about the Rohingya, an action further cementing their fate, as the leader of democracy in Burma refrained to speak out for their freedom. This time, the Muslims are Burmese citizens, not Rohingya, but this did not stop them from being attacked. Every person interviewed said that the police stood by and did nothing whilst they were being attacked. Many here believe that this was pre-planned and that the official story, that it began with a dispute in a gold shop, is just a cover for violence against Muslims. The extremist Buddhist monk, Wirathu, had only given one of his sermons ten days before the violence. His group, 969, is infamous for their extreme views and protests against Muslims who they call ‘invaders’ and ‘Kalar’ – a racist term used to describe Muslims. He is known in the country for his anti-Muslim stance, he has even published a book called ‘From the jaws of a wolf”, which tells a story of a Buddhist woman married to an abusive Muslim man. We continued throughout Mandalay, interviewing person after person displaced by the riots. But this violence was different from that in the Arakan state last year, although the anti-Muslim sentiment was the same. This time, local Buddhists and student groups from nearby Mandalay city launched a rescue operation saving hundreds of lives. The local Buddhists from Mandalay city, who have lived side by side with Muslims for centuries, were not prepared to have their neighbours slaughtered. Myint Myint, who was saved by a Buddhist monk, said she blames the Buddhists in Meiktila, not the ones in Mandalay. Her nephew, Farooq, aged just fourteen, saw people beaten to death and then burnt. His voice crackled recalling the events, he and others hid in some houses and looked on as the slaughter took place. None of the above interviewed wanted their face on camera; they fear reprisals from extremist Buddhists if they are found out to have spoken to a foreign journalist. Khin Htay Yee, was not afraid, though. She broke down in tears as she recalled how her Buddhist factory manager sheltered them in the factory as the slaughter took place outside. The mob outside threatened the manager that if he did not let the women out that they would break in and rape every last woman. She managed to make a phone call to Mandalay where some Buddhist monks had already left to rescue Muslims from the onslaught of the enraged mob. The violence took place over three days and only stopped once the army came in and restored order to the streets. The majority of the displaced are still being kept in a sports stadium in Meiktila, guarded by the military. Muslims in Burma are now afraid that the violence will spread even further and there is even a strong indication, due to protests, leaflets and military movement that a third massacre against the Rohingya Muslims in Arakan is planned for the coming days. The language of propaganda is reminiscent of that in the Balkans before the Bosnian genocide, Muslims are accused of invading, of waging jihad, of acts of violence against Buddhists, but many here believe that the military is behind the increase in violence, something Human Rights Watch pointed out in their report on the violence in Arakan last year accusing the military of complicity in the massacre. The Burmese military junta ruled Burma until recent political reforms, which has opened up the country somewhat to the West. A Muslim in Yangon told me “the military want to assert their power, and want to prove they are the ones that can restore order, they are using us to prove their point.” If this is the case, then we will see more deaths in the coming weeks. Over the last few days I have been receiving messages about Call of Duty: Modern Warfare 2.Apparently the game shows a hadith (saying of the Prophet Muhammed) on the picture frame in the bathroom. This features in the multiplayer maps, Favela. The Arabic script said “Allah is beautiful and He loves beauty”.Muslims deem it offensive to have religious text in a bathroom.The paintings having been brought to Activision and Infinity Ward’s attention, the map has been removed until it can be edited. Muslim gamers complained and spread the news via social media. We apologize to anyone who found this image offensive. Please be assured we were unaware of this issue and that there was no intent to offend. We are working as quickly as possible to remove this image and any other similar ones we may find from our various game libraries. We are urgently working to release a Title Update to remove the texture from Modern Warfare 3. We are also working to remove the texture from Modern Warfare 2 through a separate Title Update. Until the TU is ready, we have removed the Favella multiplayer map from online rotation. Activision and our development studios are respectful of diverse cultures and religious beliefs, and sensitive to concerns raised by its loyal game players. We thank our fans for bringing this to our attention. A debate I was involved in on the Voice of Russia. This studio discussion is on the protests that have spread across the Muslim world over a US made video insulting the prophet Muhammad. Those protests have now been going on for 10 days. The first began in Cairo, then the unrest spread to Libya. That cost the US ambassador Christopher Stevens his life. Protests engulfed Yemen, Sudan, Tunisia. More violent scenes have been reported in Pakistan, the Philippines and Malaysia. Exacerbating the anger is the publication in a French satirical magazine of cartoons mocking the prophet Muhammad. So are we witnessing a fundamental rift between the West and its values, which says free speech is paramount, and the Islamic world which says insults against religion should not be tolerated? VOR’s Daniel Cinna discusses this with Charlie Wolf, American broadcaster who blogs for the Daily Mail; Rodney Shakespeare, co-founder of the Global Justice Movement; Assed Baig, a freelance journalist and film maker; Dr Robert Barnidge, Professor of Law at the University of Reading. Demonstrations have spread around the world after an anti-Islam video, made by someone named Nakoula Basseley Nakoula, insulting the most revered figure of the Muslim world, the Prophet Muhammed was posted on youtube. Why is it that this short video, apparently the work of one insignificant individual, can instigate such outrage? While the filmmaker and his ilk may be a global minority, for Muslims, as well as for much of the rest of the world, they epitomise the ignorance, imperialism and arrogance of the West in its dealings with the Muslim world. The origins of the film itself are very dubious, its production values are such, that it looks like it was made in a basement. The insults to Islam or the Prophet Muhammed are obviously dubbed over the original soundtrack. The film seems to have intended provocation based on some aspect of an apocalyptic ideology. Today, as in the past, Muslims remain part of a global brotherhood that is unlike anything that exists in the West. This ‘Ummah’, the wider Muslim community, transcends political borders, artificial boundaries and international time zones.Yet, what the West apparently finds so hard to understand is that Muslims continue to have a sense of the sacred along with a respect for the concept of community as well as brother and sisterhood.For these Muslims the Prophet Muhammed is sacred. As a result of the outrage caused by this video it is now possible to see even the simplest, poorest and non-political Muslim take to the streets, as they would rather see their families shamed by such public behaviour than have their religion, which they continue to hold sacred, insulted.Even the corrupt, pro-Western, Muslim leaders recognise this, accepting that they have to speak out against any attacks on the sanctity of their religion, as their own seat of power would be in grave danger if they did not. It appears that the American establishment has been caught off guard, as is evident by its slow reaction to label the video ‘disgusting’ and ‘reprehensible’. Middle-class Muslims and non-Muslims alike talk of how Muslims should rise above the prejudice. It is not that simple since most Muslims do not come from the privileged positions necessary for such a stance. One look at the literacy rates for Afghanistan, as well as the rates at which literacy levels have fallen in Iraq since the US invasion, shows that Western intervention results in people having to choose between eating and sending their children to school.The mass education that we receive in the West is not widely available to others around the world, while, in the West we are not usually confronted by an occupational force of foreign troops every time we leave our homes or the daily psychological trauma of imminent death. While American and British troops continue fighting a war in Afghanistan, which, along with the war in Iraq and the occupation of Palestine, encourages a feeling of helplessness across the Islamic world, many Muslims ask, ‘how can we help each other and unite the Ummah?’ These are the Muslims who feel they are being globally humiliated by the policies of western governments and, with the aid of 24-hour ‘impartial’ news, their humiliation is beamed un-sanitised into homes around the world 24/7, for all to see and none to escape. Now with Muslim lands not to mention hearts and minds being occupied, along with constant attacks in the press, a perceived loss of Islamic self identity has taken hold. Is it any surprise that Muslims who see the central figure of their religion being insulted and mocked should feel dehumanised even further? Many of these Muslims feel that they have no option but to take to the streets in order to express their anger and frustration. They are fighting for what they feel is right, for what they believe in and are taking it out on any symbol of Western imperialism – embassies being the primary targets. These are the same Muslims who felt helpless when images of prisoner abuse emerged from the void of Abu Ghuraib.They are the ones who felt helpless when half a million people, or more, were killed in Iraq with millions more displaced.Helpless as Israel bombed Lebanon and Gaza and their Arab leaders belly danced around the West. Their sense of helplessness compounded as drone attacks plague Pakistan and the international blight of Guantanamo stays open for business.Helpless as the infamous Danish cartoons printed in the name of freedom of expression spread around the world like a virus. Helpless in the face of Kashmir’s continued occupation.Helpless as Bosnian women, violated and brutalised in rape camps, are denied an international forum to voice their anguish.Helpless as a flattened Grozny struggles to its feet. Helpless as America carries out drone attacks, breaching the national sovereignty of independent countries with impunity.Helpless as Switzerland, home to 400,000 Muslims, bans the building of minarets.Helpless as France bans the hijab from schools.These are the Muslims who feel helpless in every way imaginable. Is it any wonder that there is so much anger and frustration across the Islamic world? Is it wrong for humiliated and insulted Muslims to react so passionately? As the most revered figure of their religion is insulted and their lands are stolen. Or should we bring up the United States anti-terrorism,interrogation techniques such as water boarding or the many other forms of state sanctioned torture for good measure? With the media’s shouts of ‘revolution’ still ringing in our ears when Muslims recently demonstrated against their own oppressive governments, the media now shouts something different as these same Muslims protest.When these Muslims react the media cries ‘barbaric’ and ‘savage’;Eurocentric and orientalist terms that were strangely absent from public discourse during America’s ‘shock and awe’ campaign in Iraq. Imperialistic wars have seen the Muslim lands divided as arbitrary lines were drawn on maps by the Western powers with no consideration for the local people, while their religious institutions were dismantled and their cultures destroyed. Tyrannical leaders were then imposed on the population with an American or Western seal of approval.History has continually demonstrated that there is only one objective of imperialism, the exploitation of the lands natural resources which is usually facilitated by the facade of stability, democracy and freedom. The humiliation of the contemporary Muslim world, as some see it, has taken place, largely in the last century. What the imperialistic governments in the West must realise is that occupying countries and killing civilians is one thing, but to attack the religion, the sacred text and the Prophet, will bring out the masses onto the streets to fight. It will ignite the Islamic concept of ‘ghayra’, the idea that Muslims love something so much that they are willing to fight and die for it. It remains the arrogance of the West, where there is nothing really sacred anymore, to demand that everyone in the world abandon their religious beliefs in the name of civilisation and progress.While it has long been ‘funny’ to joke and mock the Christian prophet and disrespect the holy texts of Christianity, this idea is completely foreign and abhorrent to Muslims. Mocking what is held sacred has not been legitimised and integrated into the culture of the Islamic world. This video has not come out of nowhere; it is a manifestation of the environment created by the so-called ‘war on terror’. The Islamaphobia used by Western leaders to justify their wars has sparked the flames of this fire. That is why Muslims across the world will find it hard to differentiate between one crazy filmmaker and the American government as a whole. This film is a product of the environment created by America, and maybe the fire, the venom, and intolerance has become uncontrollable. I am not going to comment directly on the Citizen Khan program. I do not particularly care for so-called ethnic comedy shows that regurgitate out-of-date jokes and reinforce racist stereotypes. They are only sanctioned by the BBC because they lack real diversity in the organisation and are forced to scrape the bottom of the barrel in an ethnic box ticking exercise. What concerns me is the response the BBC has given to Muslims that have decided to engage with the broadcaster to complain about the program by dismissing them as a ‘lobbying campaign’. As a journalist that has worked within the Muslim community especially in Birmingham, I know how difficult it is to engage parts of the Muslim community when reporting. The lack of real diversity in the BBC means that the organisation is not seen as representative and international news reported by the BBC reflects badly on the organisation when local reporters hit the streets. Because of this there is a lack of trust and unwillingness, sometimes, by local communities to talk to the BBC. There is a wealth of talent at the BBC and there are many individuals who actually want real diversity and representation in the organisation. But, dismissing Muslim viewers who complain just because the BBC thinks there is a ‘lobbying campaign’ is both irresponsible and unfair. The message the BBC sends out with responses like this is that Muslims do not have a legitimate right, like other groups in the UK, to complain or engage in a civil manner with the organisation. If the BBC had any sort of contacts on the ground they would have realised that there has been a negative response from Muslims about this program. Whether people agree with the basis of the complaints or not, they still have a right to be heard and taken seriously; 200 complaints is no small matter. Unfortunately the BBC only wants to relay on the internet because it maybe lacks people on the ground that can gauge grassroots opinion from ethnic minority communities. These actions also make it very difficult for BBC staff that are making efforts to engage and involve diverse communities and get real stories out. Dismissing Muslim complaints sets efforts back in engaging communities. I suggest the BBC retract their statement that it was a ‘lobbying campaign’, and engage with their viewers that feel upset by the program. Left to right: Ibraheem aged 10, Yusuf aged 13 and Ieysaa aged 7 A Muslim family representing England in the European Chess Championships in Austria have alleged that they have been the victims of racism, Islamophobia and hate. 13-year-old Yusuf Bin-Suhayl was attacked and left bleeding by the mother of a fellow English competitor. The situation was so bad for the family that they required a police escort to their hotel and tournament. Father, Sohale Rahman has made numerous complaints to the English Chess Federation but to no avail. Throughout the competition the Rahman family who have three children representing England have been subjected to bullying and hate crime, according to Sohale. The youngest member of the family taking part is just 7-years-old. Mother, Tomasina Contu, was spat on when she asked the father of one English competitor not to bully her son. “It is of no coincidence that Tomasina wears a hijab,” said husband Sohale. The problems seem to have started from when the family asked for halal meals for themselves. Father Sohale Rahman said, “I cannot believe my family has been subjected to so much racism and Islamophobia and the English Chess Federation has just stood by and done nothing.” When contacted the English Chess Federation said, “We are aware of certain allegations in relation to some members of the English delegation in a youth tournament in Austria,” and that they are taking the allegations, “extremely seriously.” The ECF also confirmed the involvement of the Austrian police. Sohale also alleges that even after paying for the trip adequate arrangements were not made for them and no halal food was provided. “I was just told to change hotel and find a restaurant if I did not like it,” exclaimed Sohale. The Islamic Human Rights Commission has taken up the campaign for the Rahman family saying that they want to see those responsible for Islamophobia, “brought to justice.” Chair of IHRC, Massoud Shadjareh, said, “This is a shocking case of racism and Islamophobia and one that should not go unnoticed, the children are so young and should not be subjected to such hate.” Islamic Relief’s PR machine has now gone into full swing. They have launched a ruthless campaign of character assassination against me, spun with lies and inaccuracies that even Tony Blair would be proud of. Rather than do the right thing and admit their faults months ago, which could have prevented this entire ‘Relief-Gate’ scandal, they have instead tried to dodge, manipulate and lie their way out of something that is clear as day for anyone to see. Jehangir clearly asked for the aid to be delayed. If you want to know the truth of the matter, simply ask Islamic Relief if Jehangir asked for the food distribution to be delayed or not? So far they have dodged the matter. However, it might not be necessary to ask them. I have an audio recording of a conversation that took place between Jehangir and myself when he informed me that my contract would not be renewed. In it, he clearly does not deny that he attempt to delay aid. Instead, he dismisses his attempt to delay aid as ‘operational matters’. He talks about ‘chopping and changing’ things, but IR UK’s statement says that Jehangir had no control over the operations on the ground. Jehangir’s hesitation and fumbling during this recording is that of a man confronted with the truth and looking for a way out – there was a third person in the room with us forcing him to watch his words carefully. You can listen to this recording below. listen to ‘Islamic Relief UK Director referring to his attempt at delaying emergency food aid as ‘operational matters’’ on Audioboo I have nothing to gain financially from of this. I do not need or want their money. I have always had three main demands from Islamic Relief. 1) they should accept these things took place, 2) they should put processes in place to ensure that these unethical practices never take place again and 3) they should apologise for their actions. However, some individuals at Islamic Relief seem to think that just because they have the word ‘Islamic’ in their organisation’s name, that this allows them carte blanche to act as they please. This is what has led to ‘Relief-Gate’. Let’s make something clear. I do not wish to gain financially in any way whatsoever from this debacle. I have emails to prove that I clearly stated that I would not be silenced with a financial settlement, and that I wanted the ethical issues addressed. For Islamic Relief to say that I was looking for a financial settlement in return for my silence is ludicrous. I was out of work for six months and as part of the tribunal process it is required that you put down your financial costs. This was never the primary objective, nor the end. I would rather die than accept money from a charity that continues to cover up corruption and carry out the kinds of unethical practices I have described in my article. My union representative can easily verify what my demands were during the tribunal process. This email – which I sent to the CEO of Islamic Relief on the 28th of June 2012 – should be enough to prove why I pulled out from the tribunal process: “Dear Dr Ashmawey, I regret to inform you that I now feel that I have no other option but to go public with what I know. I am deeply disappointed with your findings and do not think you have taken seriously the ethical issues I raised. Because of your disregard of the serious ethical and moral concerns I will now not be doing this via an employment tribunal because it has become very clear to me that the current management has no desire for a legitimate settlement in this case.” I raised all these ethical issues as soon as I returned from East Africa. I wrote a report that was emailed out in early August. I was still an employee of Islamic Relief at the time, so the question has to be asked: what did I have to gain from raising these concerns when I did? What I wanted was to make sure the kinds of scenes I witnessed in Somalia were never repeated. What did Darrell have to gain from co-authoring the report with me and accepting to be a witness during IR’s internal investigation into my complaint about my loss of employment? He was still an employee at Islamic Relief at the time. The answer is nothing; he was simply telling the truth, and as a result, he risked his own job. I did not have to raise these issues whilst I was at Islamic Relief. I could have remained silent. I chose to speak out whilst I was there and put my position at risk. My contract was ended in October; I raised the ethical concerns I had with some of IR’s actions long before October. What does Islamic Relief think my motivations were? If I raised these issues well before the end of my contract, then how can there be any financial gain for me? IR should stop lying. The second report back from Libya was written again on my return, and emailed out in September. Islamic Relief have conveniently left out the issues from Libya that I raised in my article. Their star fundraiser, who shall remain anonymous, deliberately tweeted incorrect information prompting a response from the Head of Mission in Libya. Here is the email that was sent to IR’s fundraiser, dated the 1st September: “As we mentioned before, people are not stupid to know what is going on in the ground and they have connections everywhere. Also as I mentioned before I will not accept you publish anything without my personal approval, as I am the only one in the ground carrying out the work and not IR-UK. The medical supplies you have in that picture is not belong to IR-UK nor IRW. There was plenty of local people donation and if they find out we will be in real trouble. I am really surprised as it was clearly stated that you have to check with me before anything is published!!” It’s clear from this example that Islamic Relief UK were putting PR before anything else. Thankfully, on this occasion, the Head of Mission in Libya had the backbone to stand up to them as he clearly saw it as a risk to the work IR aid workers were doing on the ground. It is very convenient for Islamic Relief to simply dismiss Darrell’s testimony on the basis that he is my friend. However, their own internal investigation was not meant to establish the truth; it was carefully managed throughout to prove me wrong. Under their criteria for dismissing Darrell’s testimony, the investigation itself and its findings can be rubbished because of the tight knit friendships between the Human Resources Director and Jehangir. Abdullahi, the child Jehangir claimed was immediately saved by Islamic Relief, could have indeed been taken to the hospital immediately . However, Jehangir was deciding IR’s priorities on that day, and he decided that he wanted to go somewhere else rather than save Abdullahi’s life. The video I have published for all to see was filmed once the IR team returned to the camp. IR’s recent statement claims that the ITN cameraman was simply collecting cutaways while we waited for the vehicles to arrive to take Abdullahi to the hospital. This is a lie. Our cars were already there because we had just got out of them when we returned to the camp! You can hear the engines running in the background of the video. And how do they explain Darrell’s comment “Let’s get her in the car, what’s she standing there for?!” Abdullahi’s mother is clearly made to sit down in the middle of the camp with her son in her arms whilst the sun was beating down on them and our vehicles were waiting idly by to take her and Abdullahi to the hospital. Islamic Relief again lies when they attempt to quote me as saying Jehangir “went in search for famine victims”. Nowhere did I say this in my article. I said he was looking for a “malnourished child”. I have further video evidence to prove that he did not just go to – as they call it – the ‘reception’ area to meet new arrivals. Does Islamic Relief really want me to upload more videos to expose their lies? In an email addressed to me, the head of the Africa region clearly states “ Number of visitors – I think definitely over 100….”. I still have the email. Relief gate could have been avoided and it can be easily resolved. I offer Islamic Relief a way out of this embarrassing mess that they have put themselves in: make a public apology, accept your mistakes, and ensure that you will put measures in place so that these mistakes are not repeated. If you do this, I will remove my articles and any other material about Islamic Relief that I have published on the web. Some humility is required to do this on the part of Islamic Relief, but it will save a great deal of time and effort for their communications team if this is done, and save me putting up further evidence to disprove Islamic Relief’s lies against me. Islamic Relief should do their duty and stop slandering me. Statement by Darrell Williams concerning the Director of Islamic Relief UK: Assed recently wrote an article about corrupt practices he witnessed at Islamic Relief (IR). Now that IR has released a disgusting statement about him I feel I have to say something. I was also an employee of IR and I was with Assed in Somalia. Whilst I was in Kenya, I witnessed Jahangir Malik, the director of IR UK, ask Dr Ifikhar Ahmed, the head of IR’s aid response in Somalia, if a pre-planned distribution of emergency food aid in Somalia could be delayed until he arrived there a few days later. I also witnessed and filmed the ITN cameraman that Jahangir had brought with him to Somalia as he made a woman and her near death child sit down in the sun while he filmed them, even though we were attempting to take the child to the hospital. I also witnessed Jahangir lie to the media about “immediately” saving the child when we originally left the child to his fate. I was also in Libya when an IR fundraiser lied in his tweets about the aid that IR was distributing in Tripoli when he knew it wasn’t distributing any aid there. Assed raised these issues, along with myself, long before he was made unemployed after Jahangir failed to renew his contract. Assed later made a compliant that his employment was not renewed because of what he had said about Jahangir. During the subsequent investigation into this particular complaint I was called as a witness by IR, but my evidence of what I had seen in Somalia was deemed unreliable because I’m Assed’s friend. I am Assed’s friend, but I know what I saw, and I also obtained video evidence of one particular incident. By the way, Jahangir also decided not to renew my contract, despite the fact that my fellow colleagues, including my then manager, wanted my contract to be extended. I did not take them to a tribunal or ask for any money, before anyone tries to ruin this statement of mine by suggesting that I probably did. I find it shameful that IR’s recent statement on the matter has avoided answering what they dismissively call Assed’s “unmeritorious negative imputations”, and has ignored responding to the video evidence, which is very clear and freely available on YouTube. Instead, they have decided to essentially attack Assed’s character. Anyone with a clear mind can see that IR’s statement is designed to distract people from the real issue – all the claims Assed has made in his article. And what does this sentence mean in IR’s statement that it’s “ work sometimes necessitates agonising decisions”? Is this an admission that something did happen in Somalia? What “agonising decisions” does it refer to? I had travelled to East Africa as a journalist working for Islamic Relief, along with another journalist, Darrell Williams, we were responsible for collecting media material for the different Islamic Relief offices and for any news organisations to use. This is my account of what I witnessed during my time with Islamic Relief. During the devastating famine that struck Somalia last year, the Director of Islamic Relief UK, Jehangir Malik, attempted to delay emergency food distribution to starving Somalis. Jehangir Malik had traveled to East Africa with an ITN cameraman. His plan was to get coverage of Islamic Relief’s aid work in Somalia broadcast on UK television, to show potential donors that the organisation was doing good work, and to encourage them to give money so that many more Somalis could be saved. What was essential, as far as Jehangir was concerned, was for him to be present at a pre-planned distribution of food aid. This was so he could be filmed not only to show that Islamic Relief was doing vital work, but so he could also carry the authority of someone who had been to the country and seen the horror first hand. It would be easier to get money from donors if they knew the person asking for their money really knew what they were talking about – or so the thinking went. But Jehangir faced a dilemma when it was time to leave Nairobi airport in Kenya; the plane had been overbooked, and only one seat remained. The small group of Islamic relief employees stood at the check in, trying to agree who would take the last seat, and who would have to wait and catch the next flight in two days time. The problem for Jehangir was that the food aid distribution he so desperately wanted to get to was scheduled to take place that very day, whilst he stood, helplessly at the airport. At first, he suggested that out of all of us, he should be the one to take the last seat. We all knew that the head of Islamic Relief’s aid mission in Somalia, Dr Ifikhar Ahmed, should be the one to fly out first – he ran the aid effort after all, whilst Jehangir was merely a fundraiser. It was decided that Dr Iftikhar should be the one to take the final seat. That is when Jehangir turned to Dr Iftikhar and asked if we could delay the emergency food distribution until he got there. Dr Iftikhar went quiet as he considered Jehangir’s question. Jehangir repeated it, but this time said “delay the food distribution until I get there.” I was shocked by his initial question and stood there in disbelief, watching what was taking place before my very eyes. Dr Iftikhar was clearly under a lot of pressure. He needed money for Islamic Relief’s aid effort in Somalia and Jehangir was the man with his hands on the purse strings – he potentially had access to millions of pounds in fundraising revenue. As the silence lingered, and with Dr Iftikhar contemplating what to do, I had to speak up. My job was to collect media material of the work the organisation was doing in Somalia – but I was not prepared to have vital food aid delayed just to get media material. I told Dr Iftikhar to carry on with the food aid distribution and ignore Jehangir’s outrageous demand. Darrell Williams spoke out too and also added that we would just have to settle for whatever media material we could get. We were not prepared to put lives at risk for the sake of some pictures and video footage of Jehangir, even if it was for his fundraising campaign. After all, there was a famine taking place, and helping people was the primary goal here, not public relations. To this day, I cannot say with certainty whether the food distribution was delayed or not. We were shocked by Jehangir’s words, but he seemed unrepentant in his quest for PR. Once we eventually got a flight to Somalia – two days after the Nairobi airport incident – his mission to be seen as the saviour of the Somali people continued. At the first IDP camp we visited in Mogadishu – which was full of people that had left their homes in the famine effected region – Jehangir set about looking for a malnourished child. It was the kind of image he needed to ram home the message to people in the UK just how bad the famine was. Once he had found an appropriate candidate he sat down, turned to the camera that the ITN cameraman was wielding, and began a monologue about the child’s plight. This first piece of media material was never used. After walking around the camp we soon came across Abdullahi, a severely malnourished child. Jahangir asked to be filmed and again began another monologue. Abdullahi was in a clearly critical condition. I asked Jehangir and Dr Iftikhar what they were going to do for this child? They had no answer. Saving anyone wasn’t part of the plan. This “trip” was just so we could look around and bear witness to the suffering all around us, and there sure was plenty of suffering for us to see. There were people living in make shift tents and poorly erected huts, no sanitation, no clean water, and very little food. Later on that day Jehangir would tell the worlds’ media that he saved this child’s life by ‘immediately’ taking him to hospital. But the truth is very different. Jehangir left Abdullahi in the camp. He still wanted his picture taken at a food aid distribution, and there was another one scheduled to take place that very day, and he wasn’t about to miss it. Abdullahi wasn’t taken to the hospital ‘immediately’ because we were unable to take him. He wasn’t taken because, like I said, we hadn’t come to save anybody. But on our way to the food aid distribution we were told that the security situation had deteriorated at the location where it was to take place, and that the distribution had been cancelled. Fights had broken out. The sheer desperation of people wanting to feed their families had resulted in violence. That’s when Jehangir said “let’s go back (to the camp) and you can film me saving the child.” Our team headed back to the camp. When we got there, Abdullahi was not taken to the hospital ‘immediately’. This was Jehangir’s exclusive. For the first time he had managed to get UK news on board for his PR agenda to promote Islamic Relief. But at what cost? Abdullahi’s mother was taken from her tent with her severely malnourished son in her arms, but instead of taking them straight to our vehicle that was parked in the camp with the doors open, and the engine still running, Abdullahi’s mother was made to sit down in the baking sun as other residents took shelter under the shade. Jehangir’s ITN cameraman wanted her and Abdullahi to pose for the camera so he could capture the image of their complete and utter desperation. I asked Darrell to start filming this because I found it incredibly unethical and wanted to have a record of it. In our video, you can clearly hear Darrell say “Let’s get her in the car, what have we got her standing there for?!” You can hear the engines of our vehicles running in the background, waiting, as Jehangir got the vital shots that would allow him to get his exclusive. At the end of our video you can see a member of Islamic Relief’s Board of Trustees, Dr Alfy, a few metres away from this despicable incident. He watched all of this unfold before his very own eyes. Later, he denied all knowledge of the incident. I expected more from a trustee of the organisation, someone who has the responsibility of overseeing and ensuring that it is run properly. But as I was learning very quickly that PR took precedence over everything else. Abdullahi was eventually taken to hospital but not before all the media material had been obtained. I raised these issues with Jehangir in Somalia and in Kenya. He didn’t seem to care about his actions. He responded dismissively, and instead, preferred to question my role in the organisation. In Somalia we saw immeasurable suffering. Dead children and others on the brink of death; parents who had sometimes lost all of their children; starving families cramped together in makeshift shelters right next to urine and faeces. As I became acquainted with the Islamic Relief aid workers on the ground in Somalia – the ones who were actually involved in saving lives, as opposed to raising funds – they began to share their thoughts with me. They told me that the constant visitors they were receiving in Somalia from Islamic Relief’s fundraising offices around the world were slowing down the emergency relief effort. Their vital time, which should have been spent doing life saving work, was being wasted taking visitors around, just to take a look at the effects of the famine – a phenomena better known as “disaster tourism”. I raised all these issues with my boss at the time, the Director of Communications at Islamic Relief Worldwide, when I returned to the UK. Darrell and I also wrote a report detailing what we had seen in Somalia. We sent our report to the then CEO of Islamic Relief Worldwide, Saleh Saeed, who is now set to become CEO of the Disaster Emergency Committee (DEC) in September. Our report was ignored. Saleh read through it, but did not say anything. The issue was clear; Jehangir, as head of Islamic Relief UK, brought in millions of pounds of fundraising money that helped the organisation to operate. These ethical concerns were nothing in the face of all that cash and Jehangir’s OBE. In our report we highlighted the suggestion of delaying emergency food aid, the effects of disaster tourism on the aid effort in Somalia and, more importantly, the effect on the very people that the organisation was meant to be helping. At one point, I asked the head of Islamic Relief Worldwide’s aid response in Africa how many visitors had gone to Somalia since the start of the crisis there. His response? “Definitely over a hundred”. A conservative estimate of how much it cost to send one person to Somalia at the time is £2000. Overall, that comes to £200,000 of donors money, spent on people whose only job was to witness the effects of the famine, and sometimes, to report back what they had seen to others in an attempt to raise more funds for the aid effort. It’s absurd. I’m not sure donors know this, especially when they congratulate themselves on raising £50,000 in one evening, oblivious that they are funding a sort of deranged holiday for disaster tourists. This however was not the only incident that took place that made me realise how unethical the drive to raise funds could be. After my trip to Libya to collect media material I flagged up another issue. Again I co-authored a report with Darrell which was sent to the CEO Saleh Saeed. We pointed out that a prominent fundraiser from Islamic Relief UK had tweeted that Islamic Relief had been distributing medical aid and water in Tripoli even though he knew full well that this was not the case. He had been with us in Tripoli and knew that Islamic Relief, at the time, was not distributing any aid in the capital. He lied just to give the impression that Islamic Relief was doing something when in reality it wasn’t. During the conflict in Libya Islamic Relief UK had a large number of Libyans from Tripoli living in Britain who were pressuring them to do something for the people in the city they came from. This pressure must have been too much to bear for someone who had already asked these Libyans for money, and received their donations. Thankfully, staff at Islamic Relief Worldwide complained and had the tweets removed, along with pictures I had taken of the National Transitional Council (NTC) giving out water in Tripoli. None of the issues I raised were ever addressed. Instead, when Jehangir took over as Director of Communications at Islamic Relief Worldwide ( which effectively made him my boss), he refused to renew mine and Darrell’s contracts, which put an end to our time at Islamic Relief. After exhausting all the internal channels of raising this issue, before and after the termination of my employment, I was left with no other choice but to go public after the new CEO, Dr Ashmawey, failed to address my ethical concerns. For some people, the story I have just told may not be shocking; for others, they may not see anything wrong with the actions of Jehangir and his organisation at all, but I did find these actions unethical, and deeply distressing. The media and aid agencies in general have a mutually dependent relationship when it comes to humanitarian disasters: the agencies grant them access to areas and stories, whilst journalists promote the agencies and their work. All the while, journalists turn a blind eye, not only to their own unethical practices, but to the unethical practices of the aid agencies too. One journalist I spoke to remarked that “I am guilty of attending food distributions that felt like a media circus.” That is why so many in the media will see what I have said as nothing new. People in the media and the humanitarian sector know full well that these kinds of practices are common and widespread. The only thing I can do is share what I have experienced and let people make up their own minds about whether these actions are acceptable or not.

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Zoroastrian women are spirited and plucky, an old-fashioned word for courageous and determined, which sums them up perfectly. Their achievements have been the breaking of new boundaries for all of us.They campaigned with the Suffragettes and were at the heart of independence movements, like the fiery Indian revolutionary, Madame Bhikiji Cama, and Frene Ginwala, the courageous veteran of the African National Congress, who became the first woman Speaker of the post-apartheid South African National Assembly. Zoroastrian women were among the first to be admitted to higher education and the professions. Avabai Wadia founded the International Planned Parenthood Federation and used her legal skills to lead the campaign for the right to birth control. Today Maja Daruwala heads the Commonwealth Human Rights Initiative and Shireen Irani has founded the i-ProBono legal website. Professor Zenobia Nadirshaw, the clinical psychologist, is one of many outstanding women academics recognised as leaders in their fields. Others champion the cause of the oppressed and those with disabilities, women like Dhun Adenwalla who has devoted her life to those with hearing impediments. They have also been media pioneers. Homai Vyarawalla was India’s first woman photojournalist. Coomi Kapoor edited Indian Express and was president of the Indian Women’s Press Corps. Dina Vakil became the first woman editor of The Times of India, the largest circulating English language paper in the world. Bachi Karkaria was the first Indian on the Board of the World Editors Forum and is renowned for her fearless writing and AIDS campaigns. Meher Moos, the food and society columnist, has explored from the Poles to the Equator, lived with pygmies and eaten crocodile! Zoroastrian women have taken their place in every sphere of life with dignity and style. Their pioneering spirit and relentless striving after excellence have guaranteed Zerbanoo’s paternal grandmother, Gover Irani, left Iran with her family as a child refugee. Married at fourteen, she had twelve children and was widowed in her thirties. She taught Zerbanoo her Zoroastrian prayers and the need to live a good life, all while touring on a Greyhound bus in America in the early 1950s. She instilled in her granddaughter a revulsion for racial prejudice as they witnessed the harsh realities of segregation in the southern states. She also told Zerbanoo how fortunate she was to be alive in our modern times. Now, as a woman, Zerbanoo could educate herself and create a fulfilling life. It was strong, kind women like Gover who made this possible for the new generation.We need to honour and remember them. Freddie Mercury (1946 – 1991) Freddie Mercury, born Farrokh Bulsara in Zanzibar, rock legend and lead singer of Queen, continues to be voted one of the greatest singers in the history of popular music. During the millennium celebrations, his song We are the Champions was voted the most popular song of all time. Queen’s Greatest Hits is the highest selling album of all time in the UK, outselling even Mercury was ranked 58 in the BBC list of 100 Greatest Britons broadcast by the BBC, and in Japan he was voted the 52nd most influential hero of the world. Mercury’s death from AIDS was a turning point in the history of the disease. The Freddie Mercury Tribute Concert for AIDS Awareness was broadcast live to 76 countries and had an estimated audience of one billion people. Pheroza Godrej (1948 –) Pheroza Godrej is the art historian and founder of the Cymroza Art Gallery, which brought contemporary Indian art to the world stage. An active conservationist, and President of the National Society of the Friends of the Trees, she is the author of A Zoroastrian Tapestry – Art, Religion and Culture, the definitive book on Zoroastrianism, its people and heritage. Roshan Sadri (1927 – 2003) Roshan Sadri was a philanthropist and patron of the arts, known for her zest for life. She was associated with numerous charities, in particular, the Star and Garter Trust and the British Forces Appeal. With her husband, Erach, she set up the Sadri Foundation, which has been instrumental in changing many lives for the better. Mithan Tata (1895 – 1981) Mithan Tata was the first Indian woman to qualify as a barrister and to be called to Lincoln’s Inn. She practised at the Bombay High Court and was Professor of Social Legislation. Under her married name, Mithan Lam, she held many important appointments, including being the Indian delegate to the UN Commission on the Status of Women in Bhikiji Cama (1861 – 1936) Bhikiji Cama holds a unique position in India’s freedom struggle. At the International Socialist Congress in Stuttgart in 1907 she made history by unfurling the Indian flag of independence for the first time. Her dignity and dedication to see India free singled her out as the Mother of Indian Revolution. Today her portrait hangs inthe Indian parliament, the Lok Sabha. Coomi Kapoor (1946 –) Coomi Kapoor was the president of the Indian Women’s Press Corps and responsible for shaping contemporary journalism in India. Her career started as a reporter for Motherland, and she went on to be Chief Reporter for the Indian Express newspaper. After working at India Today, The Sunday Mail, The Indian Post, and Illustrated Weekly, Coomi returned to The Indian Express as the resident editor. She has also been a stringer for The Times, London and a columnist for The Star in Malaysia. Zenobia Nadirshaw (1950 –) Dr Zenobia Nadirshaw is Professor at Thames Valley University, Faculty of Health and Human Sciences. She has received many awards for her work in clinical psychology, and the way that medical and psychological services are delivered to minority communities in Britain. Zenobia is a governor of London Metropolitan University and a former governor of the Women’s Library, London. Sooni Taraporevala (1957 –) Sooni Taraporevala, the acclaimed screenwriter and photographer, is best known for her screenplays, Mississippi Masala, Such a Long Journey, and the Oscar-nominated, Salaam Bombay. Her compelling photographs have been exhibited internationally, including the Tate Modern, London. Sooni’s book, Parsis: the Zoroastrians of India – A Photographic Journey, offers rare photos, as well as historical and personal essays on the Zoroastrian religion and Parsi social history. She has kindly allowed some of her photos to be used in this exhibition. Frene Ginwala (1932 –) Frene Ginwala is a veteran of the ANC struggle against apartheid. She was the first woman Speaker of the democratically elected National Assembly of South Africa from 1994 to 2004. Under apartheid Frene smuggled the ANC deputy president, Oliver Tambo, out of South Africa. While in exile in Tanzania, Frene established and edited the journal, Spearhead. Later she made her home in Britain where she ran the ANC office. She was awarded theNorth South Prize for her outstanding achievements in the field of humanrights and was the first Chancellor of theUniversity of Kwa-Zulu Natal. Maja Daruwala (1945 –) Maja Daruwala heads the Commonwealth Human Rights Initiative and was the founder and chair of the human rights organisation, People’s Watch. She has received numerous awards for her work promoting issues of accountability, police reform and the right to information. Maja is the daughter of Field Marshal Sam Manekshaw. Avabai Wadia (1913 – 2005) Avabai Wadia was born in Sri Lanka and qualified as a barrister in London. She founded and was the President of the International Planned Parenthood Federation, which was the first nongovernmental organisation to be awarded the UN Population Award in Homai Vyarawalla (1913 – 2012) Homai Vyarawalla was India’s first woman photojournalist, renowned for her photographs of Gandhi, Nehru and India’s freedom struggle. She was a stringer for Time Life magazine and was awarded the Padma Vibhushan, India’s the second highest civilian award. Aban Marker Kabraji (1953 –) Aban Marker is the Asia Regional Director of the International Union for Conservation of Nature. She holds the Order of the Golden Ark from the Netherlands and is a McCluskey Fellow at Yale University. Aban is known for her work on conservation strategies, and security and conflict prevention. Bachi Karkaria (1945 –) Bachi Karkaria was the first Indian on the board of the World Editors Forum and served as resident editor of the Times of India. She is a household name in India for her satirical column, Erratica, and regular appearances as a commentator on current affairs. An early campaigner on AIDS, she is on the advisory body of the Bill and Melinda Dhun Adenwalla (1927 –) Dhun Adenwalla founded the Oral School for Deaf Children in Kolkata as a positive response after her eldest daughter, Dinaz, was born deaf. Working in English, the School is open to children from all socio-economic backgrounds and free to those unable to pay. In order to make the public aware of deafness, the School stages annual shows in Mime and Sign Language, with the professional Theatre of the Deaf. Shernaaz Engineer (1967 –) Shernaaz Engineer is the editor of thenewspaper, JameJamshed. She has been a journalist, editor of numerous fashion and lifestyle magazines and written several books, the latest on the Sindhi community of India. Zerbanoo Gifford (1950 –) Zerbanoo Gifford is an author, human rights campaigner, and the founder of the ASHA Centre. She has been described as one of the rare dynamic women who alter the lives of communities wherever they’ve lived. A pioneer for Asian women in British politics, she has received numerous awards around the world for her humanitarian work, combating modern slavery and championing the rights of women, children and minorities. Bapsi Sidhwa (1938 –) Bapsi Sidhwa is an award-winning novelist, best known for her work with the Indo-Canadian filmmaker, Deepa Mehta. Bapsi’s novel, Ice Candy Man, served as the basis for Mehta’s 1998 film Earth. Bapsi was on the advisory committee to the Pakistani Prime Minister, Benazir Bhutto, on Women’s Development, and has lectured at several American universities. Mahabanoo Mody-Kotwal (1944 –) Mahabanoo Mody-Kotwal has worked in film and theatre as an actress and director. She brought The Vagina Monologues to India in 2003, which raised funds for shelters for abused women in the slums of Mumbai. Rashna Writer (1949 –) Dr Rashna Writer is the Senior Teaching Fellow in the Department of Study of Religions, School of Oriental and African Studies (SOAS), London University, where she lectures on Zoroastrianism in Ancient and Modern Worlds. She is also an award-winning political analyst, specialising in advising insurance underwriters and multi-national corporations on war and terrorism risks. She is a sought-after media commentator. Meher Master Moos (1943 –) Meher Master Moos was the youngest professor of law in Canada and was awarded the prestigious UN Secretary General Dag Hammarskjoeld Award and the Albert Schweitzer Medal for humanitarian work. She also received the medal for Inter Faith Peace from His Holiness Pope John Paul II. She is the founder of the Zoroastrian College in India and a prolific writer. Meher Banaji (1943 –) Meher Banaji is the Principal of the Happy Home and School for the Blind in Mumbai. She received the President’s Award for her dedicate work with the Home’s 200 children and young people, ranging from the age of three to twenty. Nelly Sethna (1932 – 1992) Nelly Sethna was a weaver of worldwide renown, whose murals and wall hangings have been used in numerous international buildings and Air India’s Boeing 747. Despite being confined to a wheelchair she continued to weave and travel with her husband, Homi Sethna, the documentary filmmaker. Toxy Cowasjee (1939 –) Toxy Cowasjee is the acclaimed editor of Hamazor and the author of several books, including the cookbook, Manna of the Angels. A crusader for the underprivileged, whether Afghan refugees, victims of floods and earthquakes, or farmers suffering drought, Toxy is admired for her selfless campaigns. Dina Vakil (1946 –) Dina Vakil was the first woman to be appointed resident editor of the Times of India, the largest circulating English language paper in the world. She was previously the editor of The Independent, Mumbai, and prior to that, executive editor of The Indian Post, a national daily. Katy Mirza (1948 –) Katy Mirza was the first Asian bunny-girl and was offered a photographic career by The Sun newspaper on arriving in London, escaping from the conflict in her home in Aden. She became a Bollywood actress, as well as starring in the soap opera Crossroads. Today she is an award-winning interior designer. Rati Jinnah (1900 – 1929) Rati Jinnah was known as the Flower of Bombay because of her beauty and vitality. She was the only daughter of Sir Dinshaw Petit, the textile magnate. She married Mohammed Ali Jinnah, the founder of Pakistan and their only child, Dina, married Neville Wadia, the heir to the Wadia dynasty. Roshan Rivetna (1939 –) Roshan Rivetna is a nuclear physicist and computer engineer. She was the editor of FEZANA Journal from 1991 – 2005, and, together with her husband, Rohinton, is the leading light in the Federation of Zoroastrian Associations of North America. Aban Pestonjee (1936 –) Aban Pestonjee is one of the leading women entrepreneurs in the world. She is the founder of the Aban Group in Sri Lanka, the largest home and office supplier, employing over 12,000 people. Aban realised her dream of making life easier for housewives by making the latest household appliances available at affordable prices. Villoo Morawala-Patell (1955 –) Villoo Morawala-Patell is an academic entrepreneur who founded Avesthagen, a leading systems biology company focusing on the convergence of food, pharma and population genetics. She is the holder of numerous awards for her work on affordable healthcare and food security and is renowned for her business acumen. Cornelia Sorabji (1866 – 1954) Cornelia Sorabji was the first woman graduate from Bombay University, and the first woman in the world to read law at Oxford. She dedicated her life to working for the rights of women who lived in purdah and orphans. She campaigned to reform the laws on child marriages and the position of widows. Shernaz Engineer (1952 –) Shernaz Engineer founded the Verity Group which provides secretary, legal staff and IT placements. Her multimillion pound business is a by-word in the recruitment industry for its reputation for honesty, speed of service and complete reliability. Amy Rustomjee (1896 – unknown) Amy Rustomjee was among the first Indians to study at Cambridge University, going on to become one of India’s top educationalists. A member of the All India Radio ‘brains trust’, she has had halls and scholarships named after her. Kyra Shroff (1992 –) Kyra Shroff is an all-round sportswoman, taking part in basketball, football and cricket, winning the All India Karate Championship gold medal, and various athletics competitions. But her true forte is tennis. She has won several junior championships and was awarded numerous accolades for her sporting prowess. Jeroo Roy (1941 –) Jeroo Roy is an artist who is known for her paintings portraying violence against women and children. Her work has been displayed at venues as diverse as New Scotland Yard, Amnesty International and various international art galleries. Jeroo teaches art at the ASHA Centre as a means of self-expression to young people from conflict zones. Jeroo painted 250 portraits of the women featured in Zerbanoo’s Gifford’s book: Confessions to a serial womaniser: Secrets of the World’s Inspirational Women, which were displayed at the National Portrait Gallery in London. Meher Moos (1944 –) Meher Moos is known as India’s intrepid traveller. She joined Air India in 1965 as an air hostess and retired in 2002 as a Senior Executive Officer. She has explored more than 150 countries, from the Poles to the Equator. In 1981 she embarked on a five-month solitary exploration of over 35 countries in Africa, bent on discovering forbidden and inaccessible interiors, marching across the Sahara to Timbuktu and learning to live with pygmies. She is now an International Travel Consultant with Thomas Cook and a popular food and society columnist. Kitty Irani (1924 –) Kitty Irani is the daughter of Khan Bhadur Shapoor and Jerbai Mazda and was born and brought up in Kolkata. She was one of the last pupils of the child educationalists, Madame Montessori. Kitty came to London with her husband, Bailey, in the early 1950s and is the adored mother to Zerbanoo, Genie, Rustom and Naswan, a loved grandmother of Mark, Alex, George, Serene, Thomas and Caspar, and greatgrandmother to William Gool (dates unknown) Gool was Zerbanoo’s great-grandmother. She was over six feet tall and the mother of seven boys, and one daughter who died at birth. Four of her sons emigrated to India and three stayed in Iran. Her eldest son endowed one of the largest hospitals in Teheran, and her second son, Shapoor, Zerbanoo’s maternal grandfather, walked to India to start a new life for himself, where he created a business empire. Indian Suffragettes (1911) The unnamed Parsi Suffragette, first on the left campaigning for women’s right to vote, is part of a group of Indian Suffragettes on the Women’s Coronation Procession. The Indian contingent was organised by the Women’s Social and Political Union, the WSPU, whose representatives contacted Indian women living in the UK. The India procession was part of the ‘Imperial Contingent’ and was intended to show the strength of support for women’s suffrage throughout the Empire. Dolly Dastoor (1939 –) Dolly Dastoor is a professor and clinical psychologist in the field of aging and specialises in the assessment of dementia. Founder President of the Alzheimer Society, Montreal, Dolly is renowned for developing an assessment tool for the prognosis of Alzheimer’s. She is the President of Zonta International, Montreal Club, and has served on the UN Commission on the Status of Women, in Vienna. As the President of Fezana, the Federation of Zoroastrian Associations of North America, Dolly co-chaired the 7th World Zoroastrian Congress, in 2000 in Houston. Tanya Dubash (1968 –) Tanya Dubash is on the board of several Godrej Group companies and is the head of the Strategic Marketing Group. She also heads Corporate Communications and Media and oversees Godrej Nature’s Basket, a gourmet food retailing chain. She is an alumnus of the Harvard Business School and a Trustee of Brown University where she read Economics and Political Science. Nisaba Godrej (1978 –) Nisa Godrej, the younger sister of Tanya, is the President of Human Capital and Innovation for Godrej Industries and associate companies. She is written about as one of the rising young women stars of the international business world. Farangis Shahrokh (1916 – 2010) Farangis Shahrokh was a voice for the women of Iran. She lobbied for the welfare of women in prison and formed a supervisory body to ensure that they were not ill-treated. She established a clinic, nursery school and orphanage in Hamadan. Farangis also founded the Sazeman-e-Sanaye-Dastie- Irani, the Iranian Handicraft Organisation, which today is one of the most profitable organisations in Iran. Farangis set up 32 co-operatives for the technical training of artisans to improve the quality and marketing of Iranian handicrafts, which is Iran’s second largest export after oil. Anu Aga (1942 –) Anu Aga was the chair of Thermax Industries and the first woman chair of the Confederation of Indian Industries Western Region. Anu is involved in education, especially for underprivileged children, and is known for her work in corporate governance and social Meher Pudumjee (1966 –) Meher Pudumjee is the chair of Thermax, taking over from her mother, Anu Aga, in 2004. She has a post graduate degree in chemical engineering from the Imperial College of Science and Technology, London and joined Thermax in 1990 as a trainee engineer. She is also a member of the Confederation of Indian Industry’s Family Business Forum. Gover Irani (1892 – 1984) Gover Irani was Zerbanoo’s paternal grandmother. She arrived in India from Iran as a child refugee having lost her father on the boat crossing. She was the mother of twelve children, eight of whom survived to adulthood. All of them had extraordinary lives, including her son, Bailey, Zerbanoo’s father. She played a key role in bringing up Zerbanoo, who dedicated her first book, The Golden Thread: Asian Experiences of Post-Raj Britain, to her. Thrity Engineer (1942 –) Thrity Engineer is a college drop-out, serial pioneer, searcher and lover of the extraordinary, the exquisite and theexceptional. She qualified as India’s first woman gemmologist. She is the founder of 3S (Subtle Sacred Scientific), the author of Supercoherence – The 7th Sense, and the creator of The Supercoherence Programme, and works with the Luminator, the extraordinary real life ‘Star Trek’ technology of superconsciousness. Homai Daruwalla (1948 –) Homai Daruwalla was the chair and managing director of the Central Bank of India. Under her leadership the Bank underwent a steep growth of 110 per cent in total business from 2005 to 2008. Homai was also the deputy chair of the Indian Bankers’ Association. Smita Crishna (1950 –) Smita Crishna, seen here with President Jimmy Carter, is the Co-Founder of the Association for Inter-married Zoroastrians, which safeguards the rights of Zoroastrian women who married outside the community. An educationalist, she is actively involved with the Udayachal Schools at Vikhroli, Mumbai, and is the Chair of the conservation organisation, the Heritage Mile Association. Bapsybanoo Pavry, Marchioness of Winchester (1902 – 1985) Bapsybanoo Pavry was the daughter of the Parsi High Priest in Bombay. She was one of the first women to study at Columbia University in New York, and one of the first Parsi debutantes to be presented at Court. She was singled out for her beauty, and sat for Sargent, the leading portrait painter of his generation. A delegate at the UNESCO Paris Peace Conference in 1947, she was a member of council of the World Alliance for International Peace through Religion. She endowed two fellowships for the study of international relations and human rights at Oxford University in memory of her brother, Dr Zal Pavry. On her death she made an endowment of more than a million pounds for the people of Winchester, with the proviso that her portrait would hang in perpetuity in the Town Hall to mark her marriage to the Marquess of Winchester. Shireen Irani (1981 –) Shireen Irani qualified as a solicitor at Field Fisher Waterhouse, then set up i- ProBono – a website connecting civil society organisations in need of pro bono assistance with lawyers and students who want to contribute to the public good. Shireen has also worked with the human rights attorney, Judith Chomsky, and the Center for Constitutional Rights in New York. Shireen’s research has been key to several corporate human rights abuse cases establishing ‘aiding and abetting’ as an offence under international

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Melody has worked on varied projects across the globe, supporting people to be their best and to create social impact. Here’s a selection of just some of the work she has delivered. Speaking at Women’s Forum France on women’s advancementSpeaking Global Entrepreneurship Forum Malaysia on social enterpriseSpeaking on panel at Women’s Forum alongside AIG and Jonhnson Johnson execs.Speaking on stage with Archbishop Dedmond Tutu at PeaceJam Los AngelesSpeaking on stage with Nobel Laureates on social change at PeaceJam Los AngelesSpeaking on the advancement of women at the Women’s Forum main stage FranceSpeaking to Al Gore on empowering young people at Inconvenient Truth gathering for traineesSpeaking to press in Canada on InspirEngage as part of Peace WeekSpeaking Tour on Success in partnership with NCSStartup & Stilettos social media training for womenStartup & Stilettos training women from vulnerable backgroundsStartup & Stilettos traning helping women to become economically independentSuccess Speaking Tour with NCS for studentsSupporting franchisees to increase their impactSupporting people to be their bestTEDx Women in KL Malaysia 2013TEDx Women in KL MalaysiaThe Apprentice Panel at InspirEngage Bootcamp LondonThe Apprentice panelists for MADE conferenceTraining Business Owners in BahrainTraining girls in partnership with a housing associationTraining homeless young people in Indonesia on climate change with the British CouncilTraining New York Times staff ‘Human Investor’ workshop in ParisTraining SME owners to create social impact in businessTraining students at Social Enterprise ChallengeTraining students in Jordan in first of its kind programme in partnership with InjazTraining vulnerable women as part of Startup & StilettosTraining women to prosperTraining women to thrive whatever their circumstances. Startup & Stilettos trainingTraining young adults from across the MENA region to launch social enterprises with the British CouncilTraining young people at KPMG London for Princes Trust MosaicTraining young people from across East Asia Pacific on skills and climate change in Indonesia with British CouncilTraining young people in MalaysiaTraining young people on creating social change in JapanUnited Nations COP PoznanUnveiling for MADE conferenceWith Al Gore during the Inconvenient Truth Training at Cambridge UniversityWith Archbishop Desmond Tutu at PeaceJam Los AngelesWith Cherie Blair at the Women of the Future AwardsWith Claude Littner judging Enterprise Challenge for the Prince;s TrustWith fellow panelists on reality TV at BCUWith James Caan at Asian Women of Achievement AwardsWith nominees and award winners after keynote to franchiseesWith Peter Jones at PJEA awardsWith Peter Jones celebrating yougn people and enterpriseWith Prince Charles at Asian Women of Achievement AwardsWith Prince Charles at the Asian Women of Achievement AwardsWith Shirin Ebadi after a wokrshop on Peace at PeaceJam Los AngelesWomen of the Future Award winnerWomen of the Future Award with Princess Zara Aga Khan and princess Badiya bint El HassanWorking with franchiseesWorking with the Commonwealth SecretariatYoung Global Leaders Debate panel speaker in UAE 2016Accepting an award for New European’s Most Influential Woman at European Parliament BrusselsAccepting the award for Asian Women of Achievement by the Duchess and Prince CharlesActing in a film in 2016After Dinner Keynote at BMET Enteprise Academy celebrationAfter Dinner Keynote at BMET Enterprise AcademyAfter dinner keynote at Enterprise Northern IrelandAfter dinner speaker at the women’s awards BradfordAfter dinner speaker celebrating womenARK Magazine june cover Melody HossainiAs part of a 2 year programme of training young adults from across MENA for British Council. This Bootcmap in KuwaitJPGAs part of a selected committee to write a propsal paper to UNESCO on climate changeAt G8 Summit London at Lancaster HouseBBC The Apprentice 2011BBC The Apprentice TaskBeing awarded ‘Young Global Leader’ 2016 in UAECelebrating award winners at franchisees ceremonyCEO Champions Meeting at the Women’s Forum FranceCEO Champions Meeting Womens Forum 2015 Melody HossainiClosing Keynote at ‘How to Change the World’ conference in TorontoDelivering an InspirEngage Bootcamp on personal development and social enterprise in the Bahamas with Junior EnterpriseDelivering First of its kind skills training in UAEDelivering InspirEngage Bootcamp for students at Plymouth City CollegeDelivering InspirEngage Bootcamp to help enterprise finalists to launch a social enterprise for Princes Trust MosaicDelivering InspirEngage Skills Bootcamp for Princes Trust Mosaic enterprise finalistsDelivering skills training Bootcamp on social enterprise and life skills for Princes Trust MosaicDelivering Social Enterprise Revolution at Plymouth City CollegeDelivering Teacher Training in Jordan in partnership with InjazDelivering Teacher Training in UAEDelivering training in Japan for young people across East Asia PacificDWP partnership on youth job creationEmbedding more interactive training methods in education in UAE with British CouncilFilming at the Skills Show NECGuardian front page Melody HossainiHow to Change the World keynote in Toronto Canada‘I am a migrant’ campaignIdeas Britain Coach at Gherkin LondonIFS Banking professionals Masterclass LondonIn the Boardroom BBC The Apprentice Melody HossainiIn the press for EU awardInspirational Women Campaign mentoring girls Melody Hossaini social entrepreneurs in the UKInspirEngage 5 day Skills Bootcamp for British Council Middle EastInspirEngage Bootcamp as part of training teachers in UAE on implementing interactive teaching methodsInspirEngage Bootcamp for students across UK for Prince’s Trust MosaicInspirEngage Bootcamp in JordanInspirEngage Bootcamp in Qatar for British CouncilInspirEngage Bootcamp on life skills in UAE for British Council for primary school studentsInspirEngage Bootcamp training for Prince’s Trust Mosaic enterprise finalistsInspirEngage Skills Bootcamp at Manchester UniversityInspirEngage Skills Bootcamp on life skills and social enterprise for young people at KPMG LondonInteractive methods of training in InspirEngage BootcampInteractive presentation on how to change the world for studentsJ.P. Morgan panel hearing enterprise pitchesJudging Panel for Princes Trust Mosaic Enterprise Challenge competitionKamalesh Sharma secretary general of the UN at CHOGM 2009 Trinidad & TobagoKeynote at Accord Group Housing Association AGMKeynote at Commonwealth Heads of Government Meeting youth gathering in Trinidad and TobagoKeynote at Franchising conference LondonKeynote at Junior World Entrepreneurship Forum in Iran 2015Keynote at Junior World Entrepreneurship Forum Tehran Iran 2015Keynote at LSEKeynote at Round Square International Conf 2011Keynote at Round Square International Conference 2011Keynote at YMCA Oakville Peace WeekKeynote in UNESCO chamber Paris at UNESCO Youth Forum 2011 theKeynote on educational reform at the Social Enterprise Summit Hong KongKeynote on social impact and skills at LSEKeynote speaker at LSE SparksKeynote speaker at Social Enterprise West Midlands conferenceKeynote to NACUE student bodyLancaster House GCC British Conf on economyManaging the youth involvement at Education Festival UKMasterclass at IFS confernce for banking professionalsMasterclass at the Commonwealth Secretariatmelody hossaini professional speaker future of work corporates emotional intelligenceMasterclass on personal development at Oxford Brookes UniversityMasterclass on personal development for IFS banking professionalsMelody and Tom BBC The ApprenticeMelody BBC The ApprenticeMelody Hossaini 2011Melody Hossaini at Princes Trust BirminghamMelody Hossaini award winning social entrepeneur and speakerMelody Hossaini CEO InspirEngage InternationalMelody Hossaini female social entrepreneur and speakerMelody Hossaini female social entrepreneur speaker trainer coachMelody Hossaini female social entrepreneurs chairing panel at JWEF 2016 Bahrain young entrepreneurs Middle EastMelody Hossaini full lengthMelody Hossaini JWEF Bahrain 2016 social enterprise speaker InspirEngage female entrepreneur trainer the apprenticeMelody Hossaini Keynote speaker at IFSMelody Hossaini personal development expertMelody Hossaini skills trainerMelody Hossaini social changeMelody Hossaini social enterprise speakerMelody Hossaini Social Entrepreneur and trainerMelody Hossaini Social entrepreneurMelody Hossaini social entrepreneurs in the UK speaker inspirEngage LSEMelody Hossaini Speaker and PresenterMelody Hossaini speaking tourMelody Hossaini The ApprenticeMelody with Karen BBC The ApprenticeModerating panel at Junior World Entrepreneurship Forum BahrainNew European Award Winners at European Parliament BrusselsNew York Times ‘Human Investor’ training in ParisNick with Melody_The ApprenticePanel Speaker at London 2030 Summit on the Future of WorkPitching in Paris BBC The ApprenticePlan UK campaign on girlsPresenting at Intl Envoronmental Conference KuwaitPresenting at the Al Gore gathering on the Inconvenient Truth in AmsterdamPrinces Trust awards celebration as ambassadorProject Management at United Nations meeting on climate change in BonnProject Managing for British Council at UN COP gathering in CopenhagenSkills are essential but the right mindset unlocks potential. Bootcamp training for studentsSkills Bootcamp training for young adults from across Middle East on climate change for British CouncilSkills Development training for students for Prince’s Trust Mosaic life skills social skills emotional intelligence skills of the futureSky News 2011 on upskilling young peopleSky News on training young people for the world of workSocial Enterprise Bootcamp in FranceSocial Enterprise Summit Hong KongSpeaker at Junior World Entrepreneurship Forum BahrainSpeakign to press about being the face of the ‘I am a Migrant’ campaignSpeaking about Reality TV at BCUSpeaking about skills for social change and business at Young Global Leaders debate in UAESpeaking about Social Change at Accord Group Housing Association AGMSpeaking and Presenting awards to students on Social EnterpriseSpeaking at Global Entrepreneurship Summit Malaysia 2013Speaking at NACUE Student Enterprise Conf 2018Speaking at Peace One Day ForumSpeaking at Social Enterprise Conference for a collegeSpeaking at Social Enterprise Summit Hong KongSpeaking at TEDx in Malaysia on ‘Social Enterprise Revolution’Speaking at the Skills Show NECSpeaking at UNESCO Youth Forum Paris

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Surely you are familiar with the famous Srivijaya Kingdom in South Sumatra, right? Yes, I’m very sure you all have memorized and are very familiar with this very famous kingdom. How come? This famous kingdom is a kingdom with the strongest influence of Buddhism in Indonesia. As we know, there are six official religions in Indonesia, such as Buddhism. This kingdom also encouraged history Buddhism Bali from a long time ago. Many of his followers during his heyday and much construction has also been done by the Kingdom of Srivijaya in various periods of leadership of its kings. So, let’s get to know Srivijaya Kingdom heritage more! The Origin of the Srivijaya Kingdom If you trace back history, then you will find historical facts that the Kingdom of Srivijaya is one of the major kingdoms in Indonesia which is known to have strength in the maritime field. The Srivijaya kingdom had once stood in the South Sumatra region and had contributed much influence in the archipelago with various territorial powers, which stretched from Cambodia, South Thailand, the Malay Peninsula, Sumatra, West Java and possibly Central Java. Srivijaya has its own meaning according to language. In Sanskrit, sri means “glowing” or “glorious”. Meanwhile, wijaya means “victory” or “glory”. Therefore, when combined, Srivijaya has the meaning of “glorious victory”. Well, initially the evidence of the existence of the Srivijaya Kingdom came from the 7th century, from a Chinese priest who came from the Tang Dynasty, namely I Tsing. Here, I Tsing writes that he once visited the Kingdom of Srivijaya in 671 AD Wow, really interesting is not it? When you examine the Kedukan Bukit Inscription, the Sriwijaya Kingdom was first established around Palembang, on the banks of the Musi River, a very large river in Indonesia. In this inscription, it is stated that Dapunta Hyang came from Minanga Tamwan. Unfortunately, the accurate location of Minaga Tamwan has always generated debate. There is no most correct and certain theory regarding the accuracy of these locations. The first time, the theory of Palembang as a place where Srivijaya first started was proposed by Coedes and supported by Pierre-Yves Manguin. Apparently not only Palembang, several other places such as Muaro Jambi (Batanghari River, Jambi) and Muara Takus (the meeting of the Right and Left Kampar Rivers, Riau) are also thought to be the capital of Sriwijaya. Wow, cool! In its heyday, the Kingdom of Srivijaya was once the center of the trading system and was a great maritime country. Unfortunately, the Srivijaya Kingdom did not undertake efforts to expand power outside the Southeast Asian region. Hm, what a shame! Instead of enlarging his power in the Southeast Asian region, the Kingdom of Srivijaya at that time decided to contribute to the Madagascar region, which was located as far as 3,300 miles to the west. Regarding the central government, many experts who are still debating areas that are focused on being the center of the government of the Kingdom of Srivijaya. There is also the opinion that the possibility of this kingdom used to move the center of his administration with the record that the area that became the capital still governed directly by the authorities, while the supporting regions were ruled by local authorities. Unfortunately, after the heyday of course a kingdom will experience a setback. The decline of the Srivijaya Kingdom began to be felt because of several wars. An example is the war in 1025 carried out by Rajendra Chola I of Coromandel. Then, in 1183 Srivijaya’s power was under the control of the Dharmasraya kingdom. Sadly, since Srivijaya collapsed, this kingdom was forgotten and its existence was only re-discovered through a 1918 publication by the French historian George Cœdès of the École française d’Extrême-Orient. Telaga Batu Inscription Telaga Batu Inscription when it was found was in the Telaga Biru pond area, Palembang city. This inscription was discovered in 1935. Well, this inscription contains the bad curses for people who commit crimes in the Kingdom of Srivijaya. Wow, is it scary? Now, the inscription is stored neatly in the Jakarta National Museum. Telaga Batu inscription has a strong structure, carved in andesite stone with a height of 118 cm and width of 148 cm. Muara Takus Temple Next is the temple from the Kingdom of Srivijaya. Muara Takus Temple is one of the temples left by the Kingdom of Srivijaya. Want to see the splendor and beauty? You can directly visit the Muara Takus Temple in District XIII Koto, Kampar Regency, Riau. This is one of the most beautiful temples in Indonesia. Muara Takus Temple turned out to be the only Buddhist style temple in Riau, you know. Buddhism in Indonesia can be spreaded effectively by Srivijaya Kingdom’s effort. Wow, how cool! Muara Takus Temple has several buildings consisting of the eldest temple, the youngest temple, Mahligai stupa, and Palangka. Cool again, this temple has been named as one of the world heritage since 2009 by UNESCO. Actually, not only Muara Takus Temple, you can also enjoy the beautiful view of the Buddhist temple in many regions in Indonesia, such as this list of Buddhist temple in Bali Indonesia. So, it’s all about Srivijaya Kingdom heritage. As we may know before, saving our historical heritage is a must. Let’s spread goodness!

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Based loosely on the Kübler-Ross model, popularly known as the Five Stages of Grief. In chronological order: Stage #1 — Denial Dapsters cannot brain that DAP was outplayed by Mahathir who, through his “prime ministerial prerogative”, created the brand new Economic Affairs Ministry and transferred key Finance Ministry agencies to Azmin’s portfolio. Umno supreme councilor Lokman Noor Adam is charged in court today with causing hurt to student activist Wong Yan Ke. Describing last week’s assault, Wong told The Malay Mail on March 22 that “the first thing they [Umno supporters] did when they came down was shout at us asking ‘Kenapa semua Cina’ and then proceeded to walk across the streets towards us and tear up our posters and placards without any provocation from us,” said Wong. ”Why all Chinese?” Indeed there were no non Chinese among the small group demonstrating against Najib near Universiti Malaya last Friday. Continue reading “Chihuahua successfully spayed” Syed Saddiq is the epitome of Malay privilege. In Malaysia Baru, some ministers are more equal than others. In the Mahathir administration, its youngest cabinet member called for the resignation of an Indian minister twice his age – indirectly blaming Waytha Moorthy for the death of fireman Adib who had been hit by a van. This disequilibrium can only happen under the Harapan regime. Continue reading “Ketuanan Melayu in Harapan” Article below by Piers Morgan copypasted verbatim from The Daily Mail online, 25 March 2019. Cat pictures selection is mine. Disgraceful fake news witch-hunt that shames all of Trump’s deranged enemies BY PIERS MORGAN So it was all fake news… Continue reading “The 95 percent and their witch hunt” I voted BN because DAP is full of hatred. The election is already over. DAP won. But Harapan is forever Hate, not Hope. Continue reading “Vindictive politics of the Chinese” The first photo below shows a Chinese DAP-linked activist at a small protest yesterday. The second photo is from last month showing “Call me Bro”-Syed Saddiq who complained that Papagomo had him in a chokehold (really?!). Continue reading “See here Syed Saddiq — now this is a real headlock” Bukit Aman has just interrogated an Umno man over his tweet “.. elok tembak puak2 DAP ni !!!”. In New Malaysia, policing verbal expression is in full swing at the egging of the DAP. Razlan Rafii is accused by DAP’s deputy minister Hannah Yeoh (below) of encouraging “hate crime”. Razlan responded, “There are many DAP leaders who can’t speak Bahasa Malaysia well.“ So true. Continue reading “Razlan Rafii, “tembak” and is DAP a code word for Chinese/Christian?” Kadir Jasin tells the hopeless Harapan leaders to stop being “clowns” hiding in the 94 year old’s bush (jacket) — photo below. Continue reading “DAP’s debased traveling circus” As a two-term (GE13 & GE14) voter of the BN, I applaud and appreciate this brave decision by the MCA leadership. BELOW: Waiting for GE15 Continue reading “MCA will sink or swim with Umno” Two DAP leaders dropped big stink bombs and Malaysiakini, most helpfully, played their clean-up crew. Last week, Guan Eng farted a stinker that warranted almost 60 police reports lodged against him. Yes, it was a loud firecracker of a fart – and not a “faux pax” as excused by Malaysiakini – when Guan Eng declared the Umno-PAS union as tantamount to a “declaration of war” against non Malays. Continue reading “Malaysiakini deodorizing the DAP’s fart” In the 2004 parliament led by Ahmad Badawi, there were 51 Chinese MPs representing BN — see full list bottom of page. The GE11 dewan then had a total 220 seats and BN’s Chinese MPs made up 23.2 percent. In the 2018 parliament being led by Mahathir, there are 46 Chinese MPs representing Harapan — see full list bottom of page. The GE14 dewan today has a total 222 seats and Harapan’s Chinese MPs make up 20.7 percent. Continue reading “War & Peace: Comparing DAP and MCA eras” DAP, Anwar and Maharistas are in a Mexican standoff thanks to PAS and Umno. Continue reading “The Malay ABCD big tent” Dapsters = the biggest suckers I’ve always been unwaveringly confident that I’d get to enjoy my “I told you so” moment but even I had not anticipated it to come so soon. After all, it’s been – what¿ – only nine months-and-three weeks since the euphoric Dapsters were jubilantly gloating over their GE14 Ubah. Well, well, and what do we have today? Continue reading “I TOLD YOU SO, suckers!” Penang Institute is a think-tank funded by the DAP-led Penang state government. Its chairman is Penang chief minister Chow Kon Yeow. Its former chairman was Lim Guan Eng. Penang Institute executive director Ooi Kee Beng wrote Lim Kit Siang’s biography. Continue reading “Malaysiakini becoming Penang Institute mouthpiece? Wakakaka” Harapan won Semenyih nine months ago with a thumping majority of some 9,000 votes (see result details below). And that huge GE14 majority went poof! Like a mirage of magic dragon breath, it simply evaporated. Continue reading “Semenyih — Harapan’s 9k majority evaporated just like that” Answering Hannah Yeoh’s call above, Dapsters finally changed the government on 9 May 2018. And what do they get in return? A promise of flying cars. Continue reading “Hooray, the Harapan honeymoon is over!” Kerajaan yang dibina atas fitnah tak akan bertahan lama – Tok Mat I so very agree with acting Umno president Mohamad Hasan in his assessment of Harapan (video below of him speaking on the stump in Semenyih). Continue reading “Malays warm to regime change ousting Harapan” Papagomo is charged in court for insulting SS’s “modesty”. The soft-as-tissue Yang Berhormat’s … get this, M-O-D-E-S-T-Y… was apparently compromised by that hairy, muscular Gomo arm around SS’s delicate neck. Kelakar giler! Continue reading “Syed Saddiq, the LMAO-est minister in cabinet history”

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2022-05-29T11:06:46Z

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Goku was a good person, he didnt not deserve such a painful death. It’s generally believed that timelines in. In an unaltered timeline, this is Goku’s ultimate fine. Discussion. Wait, I'm lost. Unfortunately, Future Goku is one of the people who died from the Heart Virus and cannot be wished back to life with the Dragon Balls, due to his death being a natural cause. Published 9:35 am CST, Tuesday, January 19, 2021 share. Goku takes the medicine from Trunks as a preventative measure and never gets sick. Manga: "One Down..."Anime: "Double Trouble for Goku" what episode does goku wake from the heart virus in the unperfect cell saga? Future Trunks mentions that many people succumbed from the virus in his future timeline. It perhaps goes without saying, but it’s quite easy to overlook the fact that Trunks’ timeline is the original timeline. I'm trying as hard as I can to keep a straight face. By the time Goku had died, no one really knew the extent of the Heart Virus’ reach. I mean, is it ever stated in the anime or the manga exactly how and from where he got the heart virus? In one of Dragon Ball’s most realistic moments, Future Trunks comes back in time to warn Goku of the mysterious "Heart Virus" that may destroy him. Alternate names Legal and free through industry partnerships. | دراغون بول سوبر الحلقة 43. In Canon, Future Vegeta was never shown to be able to become Super Saiyan. I'm trying as hard as I can to keep a straight face. Enough people got it that they had a full cure for a virusless than 20 years later. Unfortunately, Shenlong and Porunga can only do so much, and curing a disease doesn’t fall under their jurisdiction. I just don't find the connection. When I was a kid, hearing Future Trunks exposit the details of his tragic timeline genuinely scared me (This is one of many reasons I still consider History of Trunks the best storytelling in ALL of Dragonball). Trunks (Japanese: トランクス, Hepburn: Torankusu) is a character in the Dragon Ball manga series created by Akira Toriyama.Within the series, he is the half-Saiyan half-Human son of Vegeta and Bulma and has at least two noteworthy incarnations. Senzu Beans will not stop this virus or even slow it down. In the Budokai series and Dragon Ball Z: Infinite World, it is called Viral Heart Disease and is a special capsule item that can only be used by equipping in the "custom" menu in the character selection screen. , Trunks manages to offer Goku a cure for the virus and he ends up surviving (for a time), but the fact of the matter still stands: there’s an alternate timeline where Goku dies from a mysterious illness, dooming the Earth. It perhaps goes without saying, but it’s quite easy to overlook the fact that Trunks’ timeline is the original timeline. Zenkais are received after near death experiences from battle wounds.Disease is not a wound,so no zenkai. The only character to get a zenkai boost after that was Cell when he regenerated after his self-destruct. Goku is alive! Inside this video i share my ideas on how goku got the heart virus. The Kyrptonite is lodged in Supes pretty tight, he can't pull it out. For whatever reason, Trunks’ arrival not only stalled Goku’s symptoms, but it actively prevented the rest of the world from being infected. Son Goku´s House. Goku's heart virus. I don't really connect "Son Goku" and "death". Had time travel never existed, the series would begin with Goku riding off with Bulma and end with him dying from the Heart Virus. Since no one ever gets to see Goku fight any Android at full capacity, all that can be judged is what is seen-- for Goku, its a rather quick defeat at the hands of the weakest Android. Question. Like what cause him to have the heart virus ? However, to their horror, the medicine Trunks had brought back with him from the future to cure Goku's heart virus was gone and with no way to get in contact with the future Saiyan, there was absolutely nothing that they could do. That's why I wanted to know so I … Goku is saved from death by Vegeta and taken home by Yamcha to receive the antidote. quote SgtMartin As the series goes on, the rules dictating the Dragon Balls start to lose their rigidness. ¨Gohan my theory is that he ended up in Hell with Vegeta..¨ Gohan eyed Piccolo, as if he was a child about to find out what he got for their birthday. Viral heart disease occurs when a virus attacks the heart muscle. One of the most important areas in which we're striving to do that is health. 827 827. viewing this page. ¨But the problem with that is his pure heart. The film opens with Future Goku's tragic death from a Heart Virus and the death of the Dragon Team except for Future Gohan at the hands of Android 17 and Android 18 around six months later on May 12, Age 767. 4 Answers. It is the timeline that the Dragon Ball multiverse stems from. I feel how my eyes are threatening to water but I fight against it. more or less run concurrently with one another, the butterfly effect being a non-factor, but the very first instance of time travel in the series completely shifts the timeline. The user and opponent can avoid taking damage by equipping "Vaccine", a single slot capsule item which nullifies Viral Heart Disease's effect. As soon as he triggers the form, the stress SSJ puts on the body essentially forces, An often under-analyzed facet of the Cell arc is the fact that Trunks ends up causing a butterfly effect in the main timeline. Goku awakes from heart virus (Eng Subs) I haven't seen the Japanese version of this so, why not upload it? Goku's heart virus. Goku got Heart virus from Yardrat? hide. Six months following his death, the androids appear and murder all of the Z Fighters, with the exception of Future Gohan and the Z Fighters are unable to be wished back to life, due to the Dragon Balls being permanently unusable due to Future Piccolo's death, which also kills Future Kami, thus sparking the events of Dragon Ball Z: The History of Trunks. PAID ADVERTISING. It’s only mentioned in passing, but Trunks has a very telling line about the Heart Virus. - Page 2. In the main timeline, Future Trunks arrives from the future and gives Goku the antidote to the Heart Virus (the virus is incurable when Goku first gets it, but a cure is developed soon afterward; it was just too late for Goku) after telling him about the Android threat and that he will die of a heart virus prior the Androids' arrival. Discussion. Favorite Answer. Watch and stream subbed and dubbed episodes of Dragon Ball Super online on Anime-Planet. Goku/Future Goku, Heart Virus (心臓病, Shinzōbyō) is a deadly virus that Future Goku and Goku both contract in November or December of Age 766.. Of course, Chi-Chi refused to give up without fighting. Future Goku contracts an incurable heart virus in Age 766 and dies six months before the appearance of Future Android 17 and Future Android 18; which leaves the Z Fighters without their strongest warrior. How did Goku catch the heart virus in the first place? Goku is not invincible—he is a man like any other. Of course, this being Dragon Ball, Trunks manages to offer Goku a cure for the virus and he ends up surviving (for a time), but the fact of the matter still stands: there’s an alternate timeline where Goku dies from a mysterious illness, dooming the Earth. Piccolo (was killed by #18 on May 12, Age 767 and the first to be killed by the Androids). Goku (died of a heart virus six months prior to the androids attack, roughly November - December, Age 766). re: Did Goku get a Zenkai after he recovered from the Heart virus? On Dragon Ball - General, a GameFAQs message board topic titled "Goku never gets the heart virus" - Page 3. Damned virus. By the end of the day, all the other Z Warriors knew. Vaccines minister … So i just realised that goku got the heart virus from the old man who helped him get his license to drive a vehicle. 19, turning Super Saiyan made Goku’s Heart Virus-related pain far worse. Well, things still wouldn’t go Goku’s way, as Pilaf and company were gathering the Dragon Balls at the exact same time that the Artificial Humans were fighting Piccolo. Dr. April S. Stempien-Otero, a cardiologist at the University of Washington, hopes an autopsy will show whether the virus attacked the man’s heart. Appears in Then00bAvenger 7 years ago #21. How did Goku die from the heart virus in Trunk's timeline. 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But it ’ s heart virus and never miss a beat her meals when he comes back from as... Yields better results in Dragon Ball fans Forget about, but it s! 10 Crazy Dragon Ball - General, a GameFAQs message board topic titled `` Goku died from a virus... Predator 3100 Psi Pressure Washer Parts, Toilet Paper Walmart Canada, Bnp Paribas Real Estate Salary, Decathlon Malaysia Ceo, Completing Complex Sentences Worksheet Answers, Gpu Stress Test Online, Da Increase Today News,

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2022-05-29T12:42:08Z

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Tobin, Karin; Davey-Rothwell, Melissa A; Nonyane, Bareng A S; Knowlton, Amy; Wissow, Lawrence; Latkin, Carl A Depression and depressive symptoms mediate the association between drug use and HIV risk. Yet, there are few interventions that target depressive symptoms and HIV risk for people who use drugs (PWUD). This study was a randomized controlled trial of an integrated cognitive behavioral therapy and HIV prevention intervention to reduce depressive symptoms, injection risk behaviors and increase condom use in a sample of urban people who used heroin or cocaine in the prior 6 months. A total of 315 individuals aged 18-55, who self-reported at least one HIV drug and sex risk behavior and scored ≥16 and symptoms, but weak impact on HIV risk. This trial is registered with ClinicalTrials.gov under the title "Neighborhoods, Networks, Depression, and HIV Risk" number NCT01380613. Although many people believe that mainly men get infected with HIV/AIDS, women are actually getting infected at a faster rate than men, especially in developing countries, and suffer more from the adverse impact of AIDS. As of mid-1996, the Joint UN Program on AIDS estimated that more than 10 million of the 25 million adults infected with HIV since the beginning of the epidemic are women. The proportion of HIV-positive women is growing, with almost half of the 7500 new infections daily occurring among women. 90% of HIV-positive women live in a developing country. In Asia-Pacific, 1.4 million women have been infected with HIV out of an estimated total 3.08 million adults from the late 1970s until late 1994. Biologically, women are more vulnerable than men to infection because of the greater mucus area exposed to HIV during penile penetration. Women under age 17 years are at even greater risk because they have an underdeveloped cervix and low vaginal mucus production. Concurrent sexually transmitted diseases increase the risk of HIV transmission. Women's risk is also related to their exposure to gender inequalities in society. The social and economic pressures of poverty exacerbate women's risk. Prevention programs are discussed. De Santis, Joseph P; Hauglum, Shayne D; Deleon, Diego A; Provencio-Vasquez, Elias; Rodriguez, Allan E Transgender women experience a variety of factors that may contribute to HIV risk. The purpose of this study was to explore links among HIV risk perception, knowledge, and sexual risk behaviors of transgender women. A descriptive, correlational study design was used. Fifty transgender women from the South Florida area were enrolled in the study. Transgender women completed a demographic questionnaire and standardized instruments measuring HIV risk perception, knowledge, and sexual risk behaviors. Transgender women reported low levels of HIV risk perception, and had knowledge deficits regarding HIV risk/transmission. Some participants engaged in high-risk sexual behaviors. Predictors of sexual risk behaviors among transgender women were identified. More research is needed with a larger sample size to continue studying factors that contribute to sexual risk behaviors in the understudied population of transgender women. Evidence-based guidelines are available to assist public health nurses in providing care for transgender women. Nurses must assess HIV perception risk and HIV knowledge and provide relevant education to transgender women on ways to minimize sexual risk. © 2016 Wiley Periodicals, Inc. ... Prevention VIH En Español Get Tested Find an HIV testing site near you. Enter ZIP code or city Follow HIV/AIDS CDC HIV CDC HIV/AIDS See RSS | ... Email Updates on HIV Syndicated Content Website Feedback HIV Risk and Prevention Recommend on Facebook Tweet Share ... Shan, Duo; Sun, Jiangping; Yakusik, Anna; Chen, Zhongdan; Yuan, Jianhua; Li, Tao; Fu, Jeannia; Khoshnood, Kaveh; Yang, Xing; Wei, Mei; Duan, Song; Bulterys, Marc; Sante, Michael; Ye, Runhua; Xiang, Lifen; Yang, Yuecheng We assessed HIV/AIDS expenditures in Dehong Prefecture, Yunnan Province, one of the highest prevalence regions in China, and describe funding sources and spending for different categories of HIV-related interventions and at-risk populations. 2010 HIV/AIDS expenditures in Dehong Prefecture were evaluated based on UNAIDS' National AIDS Spending Assessment methodology. Nearly 93% of total expenditures for HIV/AIDS was contributed by public sources. Of total expenditures, 52.7% was allocated to treatment and care, 24.5% to program management and administration and 19.8% to prevention. Spending on treatment and care was primarily allocated to the treatment of opportunistic infections. Most (40.4%) prevention spending was concentrated on most-at-risk populations, injection drug users (IDUs), sex workers, and men who have sex with men (MSM), with 5.5% allocated to voluntary counseling and testing. Prevention funding allocated for MSM, partners of people living with HIV and prisoners and other confined populations was low compared to the disproportionate burden of HIV/AIDS in these populations. Overall, people living with HIV accounted for 57.57% of total expenditures, while most-at-risk populations accounted for only 7.99%. Our study demonstrated the applicability of NASA for tracking and assessing HIV expenditure in the context of China, it proved to be a useful tool in understanding national HIV/AIDS response from financial aspect, and to assess the extent to which HIV expenditure matches epidemic patterns. Limited funding for primary prevention and prevention for MSM, prisoners and partners of people living with HIV, signal that resource allocation to these key areas must be strengthened. Comprehensive analyses of regional and national funding strategies are needed to inform more equitable, effective and cost-effective HIV/AIDS resource allocation. Full Text Available We assessed HIV/AIDS expenditures in Dehong Prefecture, Yunnan Province, one of the highest prevalence regions in China, and describe funding sources and spending for different categories of HIV-related interventions and at-risk populations.2010 HIV/AIDS expenditures in Dehong Prefecture were evaluated based on UNAIDS' National AIDS Spending Assessment methodology.Nearly 93% of total expenditures for HIV/AIDS was contributed by public sources. Of total expenditures, 52.7% was allocated to treatment and care, 24.5% to program management and administration and 19.8% to prevention. Spending on treatment and care was primarily allocated to the treatment of opportunistic infections. Most (40.4% prevention spending was concentrated on most-at-risk populations, injection drug users (IDUs, sex workers, and men who have sex with men (MSM, with 5.5% allocated to voluntary counseling and testing. Prevention funding allocated for MSM, partners of people living with HIV and prisoners and other confined populations was low compared to the disproportionate burden of HIV/AIDS in these populations. Overall, people living with HIV accounted for 57.57% of total expenditures, while most-at-risk populations accounted for only 7.99%.Our study demonstrated the applicability of NASA for tracking and assessing HIV expenditure in the context of China, it proved to be a useful tool in understanding national HIV/AIDS response from financial aspect, and to assess the extent to which HIV expenditure matches epidemic patterns. Limited funding for primary prevention and prevention for MSM, prisoners and partners of people living with HIV, signal that resource allocation to these key areas must be strengthened. Comprehensive analyses of regional and national funding strategies are needed to inform more equitable, effective and cost-effective HIV/AIDS resource allocation. Ikram, N.; Kamal, Q.M.; Hassan, M.U.; Tariq, H.M.; Ahmed, S.N. Background: HIV continues to be a threat in both developed and developing countries. Pakistan has entered concentrated epidemic from low epidemic stage. The prevalence of HIV is more in at risk population particularly intravenous drug users (IDUs). Studies are required to find out other risk factors contributing to spread of the disease in the general population in order to prevent the spread of disease among general population. Methods: A cross-sectional study was carried out on patients reporting for HIV testing at National HIV/STI Referral Lab, National AIDS Control Program (NACP) from January to December 2011. Results: A total of 345 patients reported to the lab during the study period. The detailed histories of 271 patients were available out of which 131 (48.3%) patients were found to be positive for HIV. Minimum age of patient with HIV was 2 years while maximum age was 64 years. HIV affected those more significantly who had visited abroad (p=0.000) or were IDUs (p=0.000). Extramarital sexual activity, blood transfusion, or any surgical procedure in the past was not found to be significant (p=0.574, p=0.243, p=0.252 respectively). Most of the affected males were drivers (16, 12.2%) by profession. Among them 9 had visited gulf countries and 4 of them were deported from the gulf countries having HIV. Conclusion: Migrant workers are a risk factor for HIV transmission. Policy may be developed to focus on this population who continues to spread HIV among their spouses and children as a result of unawareness about their HIV status and its modes of transmission. (author) Full Text Available We aimed to estimate the individual and joint impact of age, marital status and diagnosis with sexually transmitted infections (STIs on HIV acquisition among young women at a population level in Durban, KwaZulu-Natal, South Africa. A total of 3,978 HIV seronegative women were recruited for four biomedical intervention trials from 2002-2009. Point and interval estimates of partial population attributable risk (PAR were used to quantify the proportion of HIV seroconversions which can be prevented if a combination of risk factors is eliminated from a target population. More than 70% of the observed HIV acquisitions were collectively attributed to the three risk factors: younger age (<25 years old, unmarried and not cohabiting with a stable/regular partner and diagnosis with STIs. Addressing these risks requires targeted structural, behavioural, biomedical and cultural interventions in order to impact on unacceptably high HIV incidence rates among young women and the population as a whole. Full Text Available Objective. The aim of this study was to compare impulsivity and risky decision making among HIV-positive and negative heroin dependent persons. Methods. We compared different dimensions of impulsivity and risky decision making in two groups of 60 HIV-positive and 60 HIV-negative male heroin dependent persons. Each group was comprised of equal numbers of current (treatment seeker and former (abstinent heroin addicts. Data collection tools included Balloon Analogue Risk Task (BART, Iowa Gambling Task (IGT, Barratt Impulsiveness Scale (BIS, and Zuckerman Sensation Seeking Scale (SSS. Results. In SSS, comprised of four subscales including thrill and adventure seeking (TAS, experience seeking (ES, disinhibition (DIS, and boredom susceptibility (BS, there was a borderline difference in DIS (P=0.08 as HIV-positive group scored higher than HIV-negative group. Also, ES and total score were significantly higher among HIV-positive patients. In BART, HIV-positive subjects scored higher in risk taking than HIV-negative subjects as reflected in higher Average Number of puffs in Successful Balloons (ANSB. In BIS, HIV-positive group scored significantly higher in cognitive impulsivity (CI (P=0.03 and nonplanning impulsivity (NPI (P=0.05 in comparison to HIV-negative group. Also, current heroin addicts scored significantly higher in NPI compared to former addict HIV-negative participants (P=0.015. IGT did not show any significant difference between groups. Conclusion. Higher levels of impulsivity and risk taking behaviors among HIV-positive heroin addicts will increase serious concerns regarding HIV transmission from this group to other opiate dependents and healthy people. Paydary, Koosha; Mahin Torabi, Somayeh; SeyedAlinaghi, SeyedAhmad; Noori, Mehri; Noroozi, Alireza; Ameri, Sara; Ekhtiari, Hamed Objective. The aim of this study was to compare impulsivity and risky decision making among HIV-positive and negative heroin dependent persons. Methods. We compared different dimensions of impulsivity and risky decision making in two groups of 60 HIV-positive and 60 HIV-negative male heroin dependent persons. Each group was comprised of equal numbers of current (treatment seeker) and former (abstinent) heroin addicts. Data collection tools included Balloon Analogue Risk Task (BART), Iowa Gambling Task (IGT), Barratt Impulsiveness Scale (BIS), and Zuckerman Sensation Seeking Scale (SSS). Results. In SSS, comprised of four subscales including thrill and adventure seeking (TAS), experience seeking (ES), disinhibition (DIS), and boredom susceptibility (BS), there was a borderline difference in DIS (P = 0.08) as HIV-positive group scored higher than HIV-negative group. Also, ES and total score were significantly higher among HIV-positive patients. In BART, HIV-positive subjects scored higher in risk taking than HIV-negative subjects as reflected in higher Average Number of puffs in Successful Balloons (ANSB). In BIS, HIV-positive group scored significantly higher in cognitive impulsivity (CI) (P = 0.03) and nonplanning impulsivity (NPI) (P = 0.05) in comparison to HIV-negative group. Also, current heroin addicts scored significantly higher in NPI compared to former addict HIV-negative participants (P = 0.015). IGT did not show any significant difference between groups. Conclusion. Higher levels of impulsivity and risk taking behaviors among HIV-positive heroin addicts will increase serious concerns regarding HIV transmission from this group to other opiate dependents and healthy people. PMID:27051528 Price, Joan T; Rosenberg, Nora E; Vansia, Dhrutika; Phanga, Twambilile; Bhushan, Nivedita L; Maseko, Bertha; Brar, Savvy K; Hosseinipour, Mina C; Tang, Jennifer H; Bekker, Linda-Gail; Pettifor, Audrey Adolescent girls and young women (AGYW) in sub-Saharan Africa have high HIV prevalence and incidence. We sought to understand which HIV risk factors individually and in combination contribute to risk, and whether these factors are associated with HIV worry and risk perception. This study is ongoing at 4 public health centers in Lilongwe, Malawi (2016-2017). AGYW of 15-24 years old were recruited to participate in a study assessing 4 models of service delivery. At each health center, participants completed a baseline survey assessing socioeconomic, behavioral, biomedical, and partnership characteristics; self-reported HIV status; and, if HIV-uninfected, HIV risk perception (high versus low or none) and HIV worry (any versus none). We analyzed associations between baseline characteristics and HIV prevalence, risk perception, and worry. Among 1000 AGYW, median age was 19 years (IQR: 17-21). Thirty-three participants reported being HIV-infected. Fifteen characteristics were associated with HIV infection. Having more risk factors was associated with higher HIV prevalence (≤4 factors, 0.5%; 5-8 factors, 6%; >8 factors, 21%). Having more risk factors was also associated with higher risk perception (P risk factors, 52% did not consider themselves to be at high risk and 21% did not report any HIV worry. Most AGYW perceive little risk of HIV acquisition, even those at highest risk. As a critical gap in the HIV prevention cascade, accurate risk perception is needed to tailor effective and sustained combination prevention strategies for this vulnerable population. Canovari, Benedetta; Scotti, Maddalena; Acetoso, Marcello; Valentini, Massimo; Petrelli, Enzo; Magnani, Mauro Background The quantitative measurement of various HIV-1 DNA forms including total, unintegrated and integrated provirus play an increasingly important role in HIV-1 infection monitoring and treatment-related research. We report the development and validation of a SYBR Green real time PCR (TotUFsys platform) for the simultaneous quantification of total and extrachromosomal HIV-1 DNA forms in patients. This innovative technique makes it possible to obtain both measurements in a single PCR run starting from frozen blood employing the same primers and standard curve. Moreover, due to identical amplification efficiency, it allows indirect estimation of integrated level. To specifically detect 2-LTR a qPCR method was also developed. Methodology/Findings Primers used for total HIV-1 DNA quantification spanning a highly conserved region were selected and found to detect all HIV-1 clades of group M and the unintegrated forms of the same. A total of 195 samples from HIV-1 patients in a wide range of clinical conditions were analyzed with a 100% success rate, even in patients with suppressed plasma viremia, regardless of CD4+ or therapy. No significant correlation was observed between the two current prognostic markers, CD4+ and plasma viremia, while a moderate or high inverse correlation was found between CD4+ and total HIV DNA, with strong values for unintegrated HIV DNA. Conclusions/Significance Taken together, the results support the use of HIV DNA as another tool, in addition to traditional assays, which can be used to estimate the state of viral infection, the risk of disease progression and to monitor the effects of ART. The TotUFsys platform allowed us to obtain a final result, expressed as the total and unintegrated HIV DNA copy number per microgram of DNA or 104 CD4+, for 12 patients within two working days. PMID:25364909 Worm, Signe W; Kamara, David Alim; Reiss, Peter Objectives: To explore the relationship between elevated triglyceride levels and the risk of myocardial infarction (MI) in HIV-positive persons after adjustment for total cholesterol (TC), high-density lipoprotein–cholesterol (HDL-C) and nonlipid risk factors. Background: Although elevated...... triglyceride levels are commonly noted in HIV-positive individuals, it is unclear whether they represent an independent risk factor for MI. Methods: The incidence of MI during follow-up was stratified according to the latest triglyceride level. Multivariable Poisson regression models were used to describe...... the independent association between the latest triglyceride level and MI risk after adjusting for TC and HDL-C, nonlipids cardiovascular disease (CVD) risk factors, HIV and treatment-related factors. Results: The 33 308 persons included in the study from 1999 to 2008 experienced 580 MIs over 178 835 person... Häcker, Frank E K; Schmälzle, Ralf; Renner, Britta; Schupp, Harald T Field studies on HIV risk perception suggest that people rely on impressions they have about the safety of their partner. The present fMRI study investigated the neural correlates of the intuitive perception of risk. First, during an implicit condition, participants viewed a series of unacquainted persons and performed a task unrelated to HIV risk. In the following explicit condition, participants evaluated the HIV risk for each presented person. Contrasting responses for high and low HIV risk revealed that risky stimuli evoked enhanced activity in the anterior insula and medial prefrontal regions, which are involved in salience processing and frequently activated by threatening and negative affect-related stimuli. Importantly, neural regions responding to explicit HIV risk judgments were also enhanced in the implicit condition, suggesting a neural mechanism for intuitive impressions of riskiness. Overall, these findings suggest the saliency network as neural correlate for the intuitive sensing of risk. © The Author (2014). Published by Oxford University Press. For Permissions, please email: email@example.com. Maya A. Kesler Full Text Available Abstract Background Theory suggests that perceived human immunodeficiency virus (HIV risk and actual HIV risk behaviour are cyclical whereby engaging in high risk behaviour can increase perceived risk, which initiates precautionary behaviour that reduces actual risk, and with time reduces perceived risk. While current perceived risk may impact future actual risk, it is less clear how previous actual risk shapes current perceived risk. If individuals do not base their current perceived risk on past behaviour, they lose the protective effect of perceived risk motivating precautionary behaviour. Our goal was to determine the impact of actual risk on perceived risk. Methods Sexually active men who have sex with men (MSM were recruited at the Maple Leaf Medical Clinic in downtown Toronto from September 2010 to June 2012. Participants completed a socio-behavioural questionnaire using an Audio Computer Assisted Self-Interview (ACASI. Actual HIV risk (primary predictor was constructed by applying principal component analysis (PCA to eight sexual risk survey questions and comprised three components which reflected sex with casual partners, sex with HIV-positive regular partners and sex with HIV unknown status regular partners. Perceived HIV risk (outcome was measured by asking participants what the chances were that they would ever get HIV. Multivariable logistic regression was used to measure the association between actual and perceived HIV risk. Results One hundred and fifty HIV-negative MSM were recruited (median age 44.5 years [IQR 37–50 years]. Twenty percent of MSM perceived their HIV risk to be high. The odds of having a high perceived risk was significantly higher in those with high actual HIV risk indicated by low condom use with an HIV-positive regular partner compared to those with low actual HIV risk indicated by high condom use with an HIV-positive regular partner (Odds Ratio (OR 18.33, 95 % confidence interval (CI 1.65–203.45. Older Hutchinson, M. Katherine; Duan, Lei; Jemmott, Loretta S. Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters’ abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter’s HIV risk and provide them with relationship building and parent process skills to help reduce these risks. PMID:22677973 Cederbaum, Julie A; Hutchinson, M Katherine; Duan, Lei; Jemmott, Loretta S Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters' abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter's HIV risk and provide them with relationship building and parent process skills to help reduce these risks. Alison L Drake Full Text Available Women may have persistent risk of HIV acquisition during pregnancy and postpartum. Estimating risk of HIV during these periods is important to inform optimal prevention approaches. We performed a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy/postpartum and to compare mother-to-child HIV transmission (MTCT risk among women with incident versus chronic infection.We searched PubMed, Embase, and AIDS-related conference abstracts between January 1, 1980, and October 31, 2013, for articles and abstracts describing HIV acquisition during pregnancy/postpartum. The inclusion criterion was studies with data on recent HIV during pregnancy/postpartum. Random effects models were constructed to pool HIV incidence rates, cumulative HIV incidence, hazard ratios (HRs, or odds ratios (ORs summarizing the association between pregnancy/postpartum status and HIV incidence, and MTCT risk and rates. Overall, 1,176 studies met the search criteria, of which 78 met the inclusion criterion, and 47 contributed data. Using data from 19 cohorts representing 22,803 total person-years, the pooled HIV incidence rate during pregnancy/postpartum was 3.8/100 person-years (95% CI 3.0-4.6: 4.7/100 person-years during pregnancy and 2.9/100 person-years postpartum (p = 0.18. Pooled cumulative HIV incidence was significantly higher in African than non-African countries (3.6% versus 0.3%, respectively; p<0.001. Risk of HIV was not significantly higher among pregnant (HR 1.3, 95% CI 0.5-2.1 or postpartum women (HR 1.1, 95% CI 0.6-1.6 than among non-pregnant/non-postpartum women in five studies with available data. In African cohorts, MTCT risk was significantly higher among women with incident versus chronic HIV infection in the postpartum period (OR 2.9, 95% CI 2.2-3.9 or in pregnancy/postpartum periods combined (OR 2.3, 95% CI 1.2-4.4. However, the small number of studies limited power to detect associations and sources of heterogeneity Full Text Available Research Question: Whether long distance truck drivers are at a higher risk of contracting and transmitting STDs including HIV? Objectives: i To study the degree of knowledge of HIV and AIDS among long- distance truck drivers. ii Assess their sexual behaviour including condom use. iii Explore their prevailing social influences and substance abuse patterns. iv Explore their treatment seeking bahaviour as regards STDs. v Deduce their risk of contracting and transmitting STDs including HIV. Study Design: Cross- sectional interview. Setting: Transport Nagar, Indore (M.P Participants: 210 senior drivers (First drivers and 210 junior drivers (Second drivers. Study Variables: Extra-Marital sexual intercourse, condom usage, past and present history of STDs, treatment and counseling, substance abuse, social â€" cultural milieu. Outcome Variables: Risk of contraction of STDs. Statistical Analysis: Univariate analysis. Results: 94% of the drivers were totally ignorant about AIDS. 82.9% and 43.8 % of the senior and junior drivers had a history of extra- marital sex and of these only 2 regularly used condoms. 13.8% and 3.3 % of the senior and junior drivers had a past or present history suggestive of STD infection. Alcohol and Opium were regularly used by them. Conclusion: The studied drivers are at a high risk of contracting and transmitting STDs including HIV. Camacho-Gonzalez, Andres F; Wallins, Amy; Toledo, Lauren; Murray, Ashley; Gaul, Zaneta; Sutton, Madeline Y; Gillespie, Scott; Leong, Traci; Graves, Chanda; Chakraborty, Rana Youth carry the highest incidence of HIV infection in the United States. Understanding adolescent and young adult (AYA) perspectives on HIV transmission risk is important for targeted HIV prevention. We conducted a mixed methods study with HIV-infected and uninfected youth, ages 18-24 years, from Atlanta, GA. We provided self-administered surveys to HIV-infected and HIV-uninfected AYAs to identify risk factors for HIV acquisition. By means of computer-assisted thematic analyses, we examined transcribed focus group responses on HIV education, contributors to HIV transmission, and pre-sex HIV status disclosure. The 68 participants had the following characteristics: mean age 21.5 years (standard deviation: 1.8 years), 85% male, 90% black, 68% HIV-infected. HIV risk behaviors included the perception of condomless sex (Likert scale mean: 8.0) and transactional sex (88% of participants); no differences were noted by HIV status. Qualitative analyses revealed two main themes: (1) HIV risk factors among AYAs, and (2) barriers to discussing HIV status before sex. Participants felt the use of social media, need for immediate gratification, and lack of concern about HIV disease were risk factors for AYAs. Discussing HIV status with sex partners was uncommon. Key reasons included: fear of rejection, lack of confidentiality, discussion was unnecessary in temporary relationships, and disclosure negatively affecting the mood. HIV prevention strategies for AYAs should include improving condom use frequency and HIV disclosure skills, responsible utilization of social media, and education addressing HIV prevention including the risks of transactional sex. Cioe, Patricia A; Crawford, Sybil L; Stein, Michael D Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in noninfected populations has suggested that knowledge of CVD risk factors significantly influences perceptions of risk. This cross-sectional study describes CVD risk factor knowledge and risk perception in HIV-infected adults. We recruited 130 HIV-infected adults (mean age = 48 years, 62% male, 56% current smokers, mean years since HIV diagnosis, 14.7). The mean CVD risk factor knowledge score was fairly high. However, controlling for age, CVD risk factor knowledge was not predictive of perceived risk [F(1, 117) = 0.13, p > .05]. Estimated risk and perceived risk were weakly but significantly correlated; r (126) = .24, p = .01. HIV-infected adults are at increased risk for CVD. Despite having adequate risk-factor knowledge, CVD risk perception was inaccurate. Improving risk perception and developing CVD risk reduction interventions for this population are imperative. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved. Farrelly, Colleen; Cordova, David; Huang, Shi; Estrada, Yannine; Prado, Guillermo The present study examined the relationship between Berry's acculturation typology and HIV risk behaviors and whether family functioning mediated any such effects. A total of 235 high risk Hispanic adolescents were categorized into one of Berry's four acculturation typologies through the use of cut-off scores on measures of Hispanicism and Americanism. Structural equation modeling was used to examine the effects of acculturation typology on HIV risk behaviors and the indirect effects of acculturation typology on HIV risk behaviors through family functioning. Acculturation typology was related to HIV risk behaviors. Family functioning partially mediated the effects of acculturation typology on the HIV risk behavior outcomes. These findings suggest that both Americanism and Hispanicism play an important role in the etiology of HIV risk behaviors among Hispanic youth and that both, along with family functioning, are important to consider when designing preventive interventions for this population. Merchant, Roland C; Freelove, Sarah M; Langan, Thomas J; Clark, Melissa A; Mayer, Kenneth H; Seage, George R; DeGruttola, Victor G Among a random sample of emergency department (ED) patients, we sought to determine the extent to which reported risk for human immunodeficiency virus (HIV) is related to ever having been tested for HIV. A random sample of patients (aged 18-64 years) from an adult, urban, northeastern United States, academic ED were surveyed about their history of ever having been tested for HIV and their reported HIV risk behaviors. A reported HIV risk score was calculated from the survey responses and divided into 4 levels, based on quartiles of the risk scores. Pearson's X(2) testing was used to compare HIV testing history and level of reported HIV risk. Logistic regression models were created to investigate the association between level of reported HIV risk and the outcome of ever having been tested for HIV. Of the 557 participants, 62.1% were female. A larger proportion of females than males (71.4% vs 60.6%; P history of injection-drug use, were associated with prior HIV testing for both genders. In the logistic regression analyses, there was no relationship between increasing level of reported HIV risk and a history of ever having been tested for HIV for males. For females, a history of ever having been tested was related to increasing level of reported risk, but not in a linear fashion. The relationship between reported HIV risk and history of testing among these ED patients was complex and differed by gender. Among these patients, having greater risk did not necessarily mean a higher likelihood of ever having been tested for HIV. ... same age ( 1 ). The general term for these cancers is "HIV-associated cancers." Three of these cancers are known as " acquired ... also have an increased cumulative risk of developing HIV-associated cancers. What can people infected with HIV do to ... Passos, Susane Müller Klug; Souza, Luciano Dias de Mattos; Spessato, Bárbara Coiro A cross-sectional study was developed to evaluate suicide risk and associated factors in HIV/AIDS patients at a regional reference center for the treatment of HIV/AIDS in southern Brazil. We assessed 211 patients in regard to suicide risk, clinical and sociodemographic characteristics, drug use, depression, and anxiety. Suicide risk was assessed with Mini International Neuropsychiatric Interview, Module C. Multivariate analysis was performed using Poisson regression. Of the total sample, 34.1% were at risk of suicide. In the multivariate analysis, the following variables were independently associated with suicide risk: female gender; age up to 47 years; unemployment; indicative of anxiety; indicative of depression; and abuse or addiction on psychoactive substances. Suicide risk is high in this population. Psychosocial factors should be included in the physical and clinical evaluation, given their strong association with suicide risk. Bohora, Som; Chaffin, Mark; Shaboltas, Alla; Bonner, Barbara; Isurina, Galina; Batluk, Julia; Bard, David; Tsvetkova, Larissa; Skitnevskaya, Larissa; Volkova, Elena; Balachova, Tatiana The number of HIV cases attributed to heterosexual contact and the proportion of women among HIV positive individuals has increased worldwide. Russia is a country with the highest rates of newly diagnosed HIV infections in the region, and the infection spreads beyond traditional risk groups. While young women are affected disproportionately, knowledge of HIV risk behaviors in women in the general population remains limited. The objectives of this study were to identify patterns of behaviors that place women of childbearing age at high risk for HIV transmission and determine whether socio-demographic characteristics and alcohol use are predictive of the risk pattern. A total of 708 non-pregnant women, aged between 18 and 44 years, who were at risk for an alcohol-exposed pregnancy were enrolled in two regions in Russia. Participants completed a structured interview focused on HIV risk behaviors, including risky sexual behavior and alcohol and drug use. Latent class analysis was utilized to examine associations between HIV risk and other demographic and alcohol use characteristics and to identify patterns of risk among women. Three classes were identified. 34.93% of participants were at high risk, combining their risk behaviors, e.g., having multiple sexual partners, with high partner's risk associated with partner's drug use (class I). Despite reporting self-perceived risk for HIV/STI, this class of participants was unlikely to utilize adequate protection (i.e., condom use). The second high risk class included 13.19% of participants who combined their risky sexual behaviors, i.e., multiple sexual partners and having STDs, with partner's risk that included partner's imprisonment and partner's sex with other women (class II). Participants in this class were likely to utilize protection/condoms. Finally, 51.88% of participants were at lower risk, which was associated primarily with their partners' risk, and these participants utilized protection (class III). The odds Full Text Available The persistence of a reservoir of latently infected CD4 T cells remains one of the major obstacles to cure HIV. Numerous strategies are being explored to eliminate this reservoir. To translate these efforts into clinical trials, there is a strong need for validated biomarkers that can monitor the reservoir over time in vivo. A comprehensive study was designed to evaluate and compare potential HIV-1 reservoir biomarkers. A cohort of 25 patients, treated with suppressive antiretroviral therapy was sampled at three time points, with median of 2.5 years (IQR: 2.4-2.6 between time point 1 and 2; and median of 31 days (IQR: 28-36 between time point 2 and 3. Patients were median of 6 years (IQR: 3-12 on ART, and plasma viral load (<50 copies/ml was suppressed for median of 4 years (IQR: 2-8. Total HIV-1 DNA, unspliced (us and multiply spliced HIV-1 RNA, and 2LTR circles were quantified by digital PCR in peripheral blood, at 3 time points. At the second time point, a viral outgrowth assay (VOA was performed, and integrated HIV-1 DNA and relative mRNA expression levels of HIV-1 restriction factors were quantified. No significant change was found for long- and short-term dynamics of all HIV-1 markers tested in peripheral blood. Integrated HIV-1 DNA was associated with total HIV-1 DNA (p<0.001, R² = 0.85, us HIV-1 RNA (p = 0.029, R² = 0.40, and VOA (p = 0.041, R2 = 0.44. Replication-competent virus was detected in 80% of patients by the VOA and it correlated with total HIV-1 DNA (p = 0.039, R² = 0.54. The mean quantification difference between Alu-PCR and VOA was 2.88 log10, and 2.23 log10 between total HIV-1 DNA and VOA. The levels of usHIV-1 RNA were inversely correlated with mRNA levels of several HIV-1 restriction factors (TRIM5α, SAMHD1, MX2, SLFN11, pSIP1. Our study reveals important correlations between the viral outgrowth and total and integrated HIV-1 DNA measures, suggesting that the total pool of HIV-1 DNA may predict the size of the Moyer, Matthew B.; Silvestre, Anthony J.; Lombardi, Emilia L.; Taylor, Christopher A. Concerned about reports of a 15% decline in HIV testing among high-risk youth in an earlier study in Pittsburgh, this study was initiated to explore reasons why young people are not getting tested for HIV, while gathering data on their respective level of risk taking behaviors. A total of 580 surveys were collected from youth aged between 14 and… Full Text Available Recent studies reveal that teachers are more likely to engage in high-risk sexual behavior compared to the rest of the adult population. Yet the education sector could be a major vehicle for imparting knowledge and skills of avoiding and/or coping with the pandemic. This study set out to establish HIV risk behaviors among teachers in Uganda, to inform the design of a behavior change communication strategy for HIV prevention among teachers. It was a cross sectional rapid assessment conducted among primary and secondary school teachers in Kampala and Kalangala districts, in Uganda. A total of 183 teachers were interviewed. HIV risk behavior, in this study was measured as having multiple sexual partners and/or sex with a partner of unknown status without using a condom. We also considered transactional/sex for favors and alcohol use as exposures to HIV risk behavior. Odds ratios (OR and their corresponding 95% confidence intervals (CI were calculated. All data analysis was performed using SPSS version 17.0 and EPI Info Version 3.5.1. Forty five per cent of teachers reported having multiple concurrent sexual partners in the last three months, of these, only 24% acknowledged having used a condom at their last sexual encounter yet only 9.8% knew their partners’ HIV status. Teachers below 30years of age were more likely to have two or more concurrent sexual partners (OR 2.6, CI 1.31-5.34 compared to those above 30 years. Primary school teachers were less likely to involve with partners of unknown HIV status compared to secondary school teachers (OR 0.43, CI 0.19-0.97. Teachers aged below 30 years were also more likely to engage with partners of unknown HIV status compared to those above 30 years (OR 2.47, CI 1.10-5.59. Primary teachers were also less likely to have given or received gifts, money or other favors in exchange for sex (OR 0.24, CI 0.09-0.58. Teachers engage in risky sexual behaviors, which lead to HIV infection. There is need to promote Saber, Hamid Reza; Tabatabaee, Seyed Morteza; Abasian, Ali; Jamali, Mostafa; SalekMoghadam, Ebadollah; Hajibeigi, Bashir; Alavian, Seyed Moayed; Mirrezaie, Seyed Mohammad Estimation of residual risk is essential to monitor and improve blood safety. Our epidemiologic knowledge in the Iranian donor population regarding transfusion transmitted viral infections (TTIs), is confined to a few studies based on prevalence rate. There are no reports on residual risk of TTIs in Iran. In present survey, a software database of donor records of Tehran Blood Transfusion Center (TBTC) was used to estimate the incidence and residual risk of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections, by applying the incidence rate/window period (IR-WP) model. A total of 1,207,155 repeat donations was included in the analysis and represented a mean of 8.4 donations per donor over 6 years. The incidence amongst repeat donors was estimated by dividing the number of confirmed seroconverting donors by the total number of person-years at risk. The residual risk was calculated using the incidence/window period model. Incidence rate and residual risk for HBV, HCV and HIV infections were calculated for total (2005-2010) and two consecutive periods (2005-2007 and 2008-2010) of the study. According to the IR-WP model, overall residual risk for HIV and HCV in the total study period was 0.4 and 12.5 per million units, respectively and for HBV 4.57/100,000 donations. The incidence and residual risk of TTIs, calculated on TBTC's blood supply was low and comparable with developed countries for HIV infection but high for HCV and HBV infections. Blood safety may therefore be better managed by applying other techniques like nucleic acid amplification tests. Ostermann, Jan; Brown, Derek S; Mühlbacher, Axel; Njau, Bernard; Thielman, Nathan Despite substantial public health efforts to increase HIV testing, testing rates have plateaued in many countries and rates of repeat testing for those with ongoing risk are low. To inform policies aimed at increasing uptake of HIV testing, we identified characteristics associated with individuals' willingness-to-accept (WTA) an HIV test in a general population sample and among two high-risk populations in Moshi, Tanzania. In total, 721 individuals, including randomly selected community members (N = 402), female barworkers (N = 135), and male Kilimanjaro mountain porters (N = 184), were asked in a double-bounded contingent valuation format if they would test for HIV in exchange for 2000, 5000 or 10,000 Shillings (approximately $1.30, $3.20, and $6.40, respectively). The study was conducted between September 2012 and February 2013. More than one quarter of participants (196; 27 %) stated they would be willing to test for Tanzania Shilling (TSH) 2000, whereas one in seven (98; 13.6 %) required more than TSH 10,000. The average WTA estimate was TSH 4564 (95 % Confidence Interval: TSH 4201 to 4927). Significant variation in WTA estimates by gender, HIV risk factors and other characteristics plausibly reflects variation in individuals' valuations of benefits of and barriers to testing. WTA estimates were higher among males than females. Among males, WTA was nearly one-third lower for those who reported symptoms of HIV than those who did not. Among females, WTA estimates varied with respondents' education, own and partners' HIV testing history, and lifetime reports of transactional sex. For both genders, the most significant association was observed with respondents' perception of the accuracy of the HIV test; those believing HIV tests to be completely accurate were willing to test for approximately one third less than their counterparts. The mean WTA estimates identified in this study suggest that within the study population, incentivized universal HIV Shaw, Stacey A; El-Bassel, Nabila This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV. Mukanyangezi, M F; Sengpiel, V; Manzi, O; Tobin, G; Rulisa, S; Bienvenu, E; Giglio, D Cervical cancer is the major cause of death from cancer in Africa. We wanted to assess the prevalence of human papillomavirus (HPV) infections and associated risk factors and to determine whether HPV testing could serve as a screening method for squamous intraepithelial lesions (SILs) in Rwanda. We also wanted to obtain a broader understanding of the underlying risk factors for the establishment of HPV infection in Rwanda. A total of 206 HIV-positive women, 172 HIV-negative women and 22 women with unknown HIV status were recruited at the University Teaching Hospitals of Kigali (UTHK) and of Butare (UTHB) in Rwanda. Participants underwent an interview, cervical sampling for a Thinprep Pap test and a screening test analysing 37 HPV strains. Only 27% of HIV-positive women and 7% of HIV-negative women had been screened for cervical cancer before. HPV16 and HPV52 were the most common HPV strains. HIV-positive women were more commonly infected with high-risk (HR) HPV and multitype HPV than HIV-negative women. The sensitivity was 78% and the specificity 87% to detect high-grade SIL (HSIL) with HPV screening. Among HIV-negative women, being divorced was positively associated with HR-HPV infection, while hepatitis B, Trichomonas vaginalis infection and HR-HPV infection were factors positively associated with SILs. Ever having had gonorrhoea was positively associated with HR-HPV infection among HIV-positive women. HR-HPV infection and the number of live births were positively associated with SILs. The currently used quadrivalent vaccine may be insufficient to give satisfactory HPV coverage in Rwanda. HPV Screening may be effective to identify women at risk of developing cervical cancer, particularly if provided to high-risk patients. © 2017 British HIV Association. Drake, Alison L.; Wagner, Anjuli; Richardson, Barbra; John-Stewart, Grace Background Women may have persistent risk of HIV acquisition during pregnancy and postpartum. Estimating risk of HIV during these periods is important to inform optimal prevention approaches. We performed a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy/postpartum and to compare mother-to-child HIV transmission (MTCT) risk among women with incident versus chronic infection. Methods and Findings We searched PubMed, Embase, and AIDS-related conference abstracts between January 1, 1980, and October 31, 2013, for articles and abstracts describing HIV acquisition during pregnancy/postpartum. The inclusion criterion was studies with data on recent HIV during pregnancy/postpartum. Random effects models were constructed to pool HIV incidence rates, cumulative HIV incidence, hazard ratios (HRs), or odds ratios (ORs) summarizing the association between pregnancy/postpartum status and HIV incidence, and MTCT risk and rates. Overall, 1,176 studies met the search criteria, of which 78 met the inclusion criterion, and 47 contributed data. Using data from 19 cohorts representing 22,803 total person-years, the pooled HIV incidence rate during pregnancy/postpartum was 3.8/100 person-years (95% CI 3.0–4.6): 4.7/100 person-years during pregnancy and 2.9/100 person-years postpartum (p = 0.18). Pooled cumulative HIV incidence was significantly higher in African than non-African countries (3.6% versus 0.3%, respectively; pHIV was not significantly higher among pregnant (HR 1.3, 95% CI 0.5–2.1) or postpartum women (HR 1.1, 95% CI 0.6–1.6) than among non-pregnant/non-postpartum women in five studies with available data. In African cohorts, MTCT risk was significantly higher among women with incident versus chronic HIV infection in the postpartum period (OR 2.9, 95% CI 2.2–3.9) or in pregnancy/postpartum periods combined (OR 2.3, 95% CI 1.2–4.4). However, the small number of studies limited power to detect associations and sources of Chew, Erin Y; Hartman, Christine M; Richardson, Peter A; Zevallos, Jose P; Sikora, Andrew G; Kramer, Jennifer R; Chiao, Elizabeth Y To evaluate HIV-related and other clinical risk factors associated with oropharynx cancer (OPSCC) in HIV-infected U.S. Veterans. Retrospective cohort study utilizing Veterans Affairs HIV Clinical Case Registry (CCR) data from 1985 to 2010. Outcome was incident OPSCC as indicated by 1 inpatient or 2 outpatient ICD-9 codes. Cox proportional hazard models were used to determine hazard ratios (HR) and 95% confidence intervals (CI) for each risk factor on the time to OPSCC diagnosis. A total of 40,996 HIV-infected male veterans were included in the cohort with 97 cases of OPSCC. The age adjusted incidence rate was 23.2/100,000 [95% CI 17.8-29.2]. Age>50 (aHR=3.8, 95% CI 1.9-7.8), recent CD4<200 (aHR=3.8, 95% CI 2.0-7.3), and undetectable HIV viral loads 40-79% of the time (aHR=1.8, 95% CI 1.1-3.0) were associated with an increased risk of OPSCC. Era of HIV diagnosis, utilization of cART, nadir CD4 count, race, smoking history, and previous risk of HPV disease, including condyloma or invasive squamous cell carcinoma of the anus (SCCA) were not associated with increased risk of OPSCC. Patients who were older at beginning of follow up, had lower CD4 counts around the time of OPSCC diagnosis, and moderate HIV viral control during follow-up had an increased risk of OPSCC. Other HPV-related diseases such as SCCA and condyloma did not increase the risk for OPSCC. Copyright © 2017 Elsevier Ltd. All rights reserved. Eaton, Lisa A; West, Tessa V; Kenny, David A; Kalichman, Seth C Selecting sex partners of the same HIV status or serosorting is a sexual risk reduction strategy used by many men who have sex with men. However, the effectiveness of serosorting for protection against HIV is potentially limited. We sought to examine how men perceive the protective benefits of factors related to serosorting including beliefs about engaging in serosorting, sexual communication, and perceptions of risk for HIV. Participants were 94 HIV negative seroconcordant (same HIV status) couples, 20 HIV serodiscordant (discrepant HIV status) couples, and 13 HIV positive seroconcordant (same HIV status) couples recruited from a large gay pride festival in the southeastern US. To account for nonindependence found in the couple-level data, we used multilevel modeling which includes dyad in the analysis. Findings demonstrated that participants in seroconcordant relationships were more likely to believe that serosorting reduces concerns for condom use. HIV negative participants in seroconcordant relationships viewed themselves at relatively low risk for HIV transmission even though monogamy within relationships and HIV testing were infrequent. Dyadic analyses demonstrated that partners have a substantial effect on an individual's beliefs and number of unprotected sex partners. We conclude that relationship partners are an important source of influence and, thus, intervening with partners is necessary to reduce HIV transmission risks. Schwitters, Amee; Sabatier, Jennifer; Seth, Puja; Glenshaw, Mary; Remmert, Dietrich; Pathak, Sonal; Bock, Naomi Namibia's HIV prevalence is 13.3%. Alcohol is associated with sexual risk-taking, leading to increased HIV risk. Baseline sexual behaviors, HIV and alcohol knowledge, and self-perceived HIV risk were examined among men reporting high-risk drinking in Katutura, Namibia. HIV negative men, ≥ 18 years, were screened for harmful or hazardous levels of drinking and >1 recent sex partner prior to randomization into control or intervention arm. SAS 9.3 and R 3.01 were used for descriptive baseline cohort analyses. A total of 501 participants who met criteria were included in analysis (mean Alcohol Use Disorders Identification Test [AUDIT] =12.4). HIV and alcohol knowledge were high with the majority (>85 and 89.8-98%, respectively) of respondents correctly answering assessment questions. Despite high knowledge levels, 66.7% of men felt they were at some or high risk of HIV acquisition. Among those respondents, 56.5% stated often wanting to have sex after drinking and 40.3% stated sex was better when drunk. Among respondents with non-steady partners [n = 188], 44.1% of last sexual encounters occurred while the participant was drunk and condoms were not used 32.5% of those times. Among persons who were not drunk condoms were not used 13.3% of those times. Sex with casual partners was high. Inconsistent condom use and alcohol use before sex were frequently reported. Increased emphasis on alcohol risk-reduction strategies, including drinking due to peer pressure and unsafe sexual behaviors, is needed. Plowden, Keith O; Fletcher, Audwin; Miller, J Lawrence Urban African Americans are disproportionately affected by HIV, the virus associated with AIDS. Although incidence and mortality appear to be decreasing in some populations, they continue to remain steady among inner-city African Americans. A major concern is the number of HIV-positive individuals who continue to practice high-risk behaviors. Understanding factors that increase risks is essential for the development and implementation of effective prevention initiatives. Following a constructionist epistemology, this study used ethnography to explore social and cultural factors that influence high-risk behaviors among inner-city HIV-positive African Americans. Leininger's culture care diversity and universality theory guided the study. Individual qualitative interviews were conducted with HIV-positive African Americans in the community to explore social and cultural factors that increase HIV-risky behaviors. For this study, family/kinship, economic, and education factors played a significant role in risky behaviors. Reducing HIV disparity among African Americans is dependent on designing appropriate interventions that enhance protective factors. Clinicians providing care to HIV-positive individuals can play a key role in reducing transmission by recognizing and incorporating these factors when designing effective prevention interventions. Camacho-Gonzalez, Andres F.; Wallins, Amy; Toledo, Lauren; Murray, Ashley; Gaul, Zaneta; Sutton, Madeline Y.; Gillespie, Scott; Leong, Traci; Graves, Chanda; Chakraborty, Rana Youth carry the highest incidence of HIV infection in the United States. Understanding adolescent and young adult (AYA) perspectives on HIV transmission risk is important for targeted HIV prevention. We conducted a mixed methods study with HIV-infected and uninfected youth, ages 18–24 years, from Atlanta, GA. We provided self-administered surveys to HIV-infected and HIV-uninfected AYAs to identify risk factors for HIV acquisition. By means of computer-assisted thematic analyses, we examined t... Felsher, Marisa; Koku, Emmanuel Risk multiplexity (i.e., overlap in drug-use, needle exchange and sexual relations) is a known risk factor for HIV. However, little is known about predictors of multiplexity. This study uses egocentric data from the Colorado Springs study to examine how individual, behavioral and social network factors influence engagement in multiplex risk behavior. Analyses revealed that compared to Whites, Hispanics were significantly more likely to engage in risk multiplexity and Blacks less so. Respondents who were similar to each other (e.g., in terms of race) had significantly higher odds of being in risk multiplex relationships, and respondents' risk perceptions and network size were significantly associated with engaging in multiplex risk behaviors. Findings from interaction analysis showed the effect of knowing someone with HIV on the odds of multiplexity depends partly on whether respondents' know their HIV status. Findings suggest that demographics, HIV behaviors and network factors impact engagement in multiplex risk behaviors, highlighting the need for multi-level interventions aimed at reducing HIV risk behavior. Wolitski, Richard J; Pals, Sherri L; Kidder, Daniel P; Courtenay-Quirk, Cari; Holtgrave, David R HIV-related stigma negatively affects the lives of persons living with HIV/AIDS (PLWHA). Homeless/unstably housed PLWHA experience myriad challenges and may be particularly vulnerable to the effects of HIV-related stigma. Homeless/unstably housed PLWHA from 3 U.S. cities (N = 637) completed computer-assisted interviews that measured demographics, self-assessed physical and mental health, medical utilization, adherence, HIV disclosure, and risk behaviors. Internal and perceived external HIV stigma were assessed and combined for a total stigma score. Higher levels of stigma were experienced by women, homeless participants, those with a high school education or less, and those more recently diagnosed with HIV. Stigma was strongly associated with poorer self-assessed physical and mental health, and perceived external stigma was associated with recent non-adherence to HIV treatment. Perceived external stigma was associated with decreased HIV disclosure to social network members, and internal stigma was associated with drug use and non-disclosure to sex partners. Interventions are needed to reduce HIV-related stigma and its effects on the health of homeless/unstably housed PLWHA. Westreich, Daniel; Cates, Jordan; Cohen, Mardge; Weber, Kathleen M; Seidman, Dominika; Cropsey, Karen; Wright, Rodney; Milam, Joel; Young, Mary A; Mehta, C Christina; Gustafson, Deborah R; Golub, Elizabeth T; Fischl, Margaret A; Adimora, Adaora A Cigarette smoking during pregnancy increases risks of poor pregnancy outcomes including miscarriage and stillbirth (pregnancy loss), but the effect of smoking on pregnancy loss among HIV-infected women has not been explored. Here, investigated the impact of smoking on risk of pregnancy loss among HIV-positive and HIV-negative women, and estimated the potential impact of realistic smoking cessation interventions on risk of pregnancy loss among HIV-positive women. We analyzed pregnancy outcomes in HIV-positive and HIV-negative participants in the Women's Interagency HIV Study between 1994 and 2014. We estimated effects of current smoking at or immediately before pregnancy on pregnancy loss; we controlled for confounding using regression approaches, and estimated potential impact of realistic smoking cessation interventions using a semiparametric g-formula approach. Analysis examined 1033 pregnancies among 659 women. The effect of smoking on pregnancy loss differed dramatically by HIV status: adjusted for confounding, the risk difference comparing current smokers to current nonsmokers was 19.2% (95% confidence limit 10.9-27.5%) in HIV-positive women and 9.7% (95% confidence limit 0.0-19.4%) in HIV-negative women. These results were robust to sensitivity analyses. We estimated that we would need to offer a realistic smoking cessation intervention to 36 women to prevent one pregnancy loss. Smoking is a highly prevalent exposure with important consequences for pregnancy in HIV-positive pregnant women in the United States, even in the presence of potent highly active antiretroviral therapy. This evidence supports greater efforts to promote smoking cessation interventions among HIV-positive women, especially those who desire to become pregnant. Omland, Silje Haukali; Ahlström, Magnus Glinvad; Gerstoft, Jan BACKGROUND: The risk of skin cancer in HIV-infected patients has not been extensively studied. OBJECTIVE: To determine the risk of skin cancer in HIV-infected patients and compare it with the risk in the background population. METHODS: In a matched, nationwide population-based cohort study we...... compared the risk of skin cancer in 4280 HIV-infected patients from the Danish HIV cohort study with a background population cohort, according to the level of immunosuppression and route of transmission. Primary outcomes were time to first basal cell carcinoma (BCC), squamous cell carcinoma (SCC... Frye, Margaret; Chae, Sophia Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. We examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country's severe AIDS epidemic. We use interviewers' ratings of respondents' attractiveness, along with HIV test results and women's assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15-35. Results show that women who are rated by interviewers as 'much less' or 'less' attractive than other women their age are 9% more likely to test positive for HIV. We also find that attractiveness is associated with women's own assessments of their HIV risk: Among women who tested negative, those perceived as 'much less' or 'less' attractive than average report themselves to be at greater risk of HIV infection. These results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings. Søgaard, Ole S; Lohse, Nicolai; Østergaard, Lars Jørgen Early identification of persons with undiagnosed HIV infection is an important health care issue. We examined associations between diseases diagnosed in hospitals and risk of subsequent HIV diagnosis.......Early identification of persons with undiagnosed HIV infection is an important health care issue. We examined associations between diseases diagnosed in hospitals and risk of subsequent HIV diagnosis.... Steel, Jennifer; Herlitz, Claes; Matthews, Jesse; Snyder, Wendy; Mazzaferro, Kathryn; Baum, Andy; Theorell, Töres This study examined the relationship between pre-migration trauma and HIV-risk behavior in refugees from sub-Saharan Africa. The sample comprised 122 persons who had emigrated from sub-Saharan Africa and were currently residing in Sweden. Qualitative methods including individual interviews, focus groups, and interviews with key informants addressed questions regarding trauma experience and HIV-risk behavior. A history of pre-migration trauma was found to be associated with HIV-risk behavior. According to the participants, symptoms associated with post-traumatic stress disorder, depression, adjustment disorder, and substance use mediated the relationship between pre-migration trauma and sexual risk behavior. In contrast, a minority of the participants who reported pre-migration trauma but not psychological sequelae, or experienced post-traumatic growth, reported safer sexual practices. It appears that for some individuals, pre-migration trauma resulted in psychiatric sequelae, which may increase an individual's risk to be infected with HIV. Interventions targeted at individuals at increased risk (i.e. pre-migration trauma with unresolved psychiatric symptomatology) may facilitate the prevention of HIV and other sexually transmitted diseases in this population. Integration of multiple psychosocial and health issues is recommended for comprehensive treatment and prevention programs. ... A-Glance Project Connect Sexual Health STD Teen Pregnancy Sexual Risk Behaviors: HIV, STD, & Teen Pregnancy Prevention Recommend on Facebook Tweet ... their risk for HIV , other STDs , and unintended pregnancy . The National HIV/AIDS Strategy calls for all Americans to be ... Stringer, Elizabeth M.; Sinkala, Moses; Kumwenda, Rosemary; Chapman, Victoria; Mwale, Alexandrina; Vermund, Sten H.; Goldenberg, Robert L.; Stringer, Jeffrey S.A. One quarter of pregnant women in Zambia are infected with HIV. Understanding how knowledge of HIV relates to personal risk perception and avoidance of risky behaviors is critical to devising effective HIV prevention strategies. In conjunction with a large clinical trial in Lusaka, Zambia, we surveyed postpartum women who had been tested for HIV but did not know their status before undergoing the questionnaire. Of 858 women for whom complete data were available, 248 (29%) were HIV infected. Women 22 years of age or older (adjusted odds ratio [AOR], 1.7; 95% confidence interval [CI], 1.1–2.5), women reporting ≥2 sexual partners in their lifetime (AOR, 1.8; 95% CI, 1.3–2.5), and women reporting a history of a sexually transmitted infection (AOR, 2.7; 95% CI, 1.7–4.3) were more likely to be HIV infected. Having had ≥2 lifetime sexual partners was a marker for perception of high personnel risk for HIV infection (AOR, 1.5; 95% CI, 1.1–2.1). However, there was no relationship between perceived risk of HIV infection and actual HIV status. In fact, 127 (52%) of 245 women who stated that they were at no or low risk for HIV infection were HIV infected. Living in an area of high HIV seroprevalence like Zambia seems to be the greatest risk factor for infection in unselected pregnant women. Before significant inroads can be made in decreasing the incidence of HIV infection among pregnant women, population-based strategies that involve men must be implemented. PMID:14707794 Full Text Available Background: Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. Objective: We examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country's severe AIDS epidemic. Methods: We use interviewers' ratings of respondents' attractiveness, along with HIV test results and women's assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15‒35. Results: Results show that women who are rated by interviewers as 'much less' or 'less' attractive than other women their age are 9Š more likely to test positive for HIV. We also find that attractiveness is associated with women's own assessments of their HIV risk: Among women who tested negative, those perceived as 'much less' or 'less' attractive than average report themselves to be at greater risk of HIV infection. Conclusions: These results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. Contribution: This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings. Full Text Available Abstract Background HIV testing and counseling (HTC with linkage to care after known infection are key components for HIV transmission prevention. This study was conducted to assess HTC uptake, HIV risk perception and linkage to care among Thai university students. Methods An outreach HTC program was conducted in a large public university in Thailand from January 2013 to December 2014. The program consisted of brief HIV knowledge assessment, free HTC, HIV risk assessment and education provided by the healthcare personnel. Students were categorized into low, moderate and high-risk groups according to the pre-defined HIV risk characteristics. Results One-thousand-eight-hundred-one students participated in the program, 494 (27 % underwent HTC. Independent characteristics associated with no HTC uptake included female sex (P < 0.001, lower HIV knowledge score (P < 0.001, younger age (P < 0.001 and students from non-health science faculties (P = 0.02. Among the 494 students undergoing HTC, 141 (29 % were categorized into moderate or high-risk group, of whom 45/141 (32 % had false perception of low HIV risk. Being heterosexual was independently associated with false perception of low HIV risk (P = 0.04. The rate of new HIV infection diagnosis was 4/494 (0.8 %. Of these 4 HIV-infected students, 3 (75 % were men who have sex with men and only 2 of the 4 students (50 % showed up for HIV continuity care. Conclusions An outreach HIV prevention program with HTC was feasible and beneficial in detecting HIV risk and infection among the university students. However, interventions to improve HTC uptake, HIV risk perception and linkage to care are needed. Tyler, Kimberly A The purpose of this study was to examine the relationship between homeless youths' HIV risk behaviors with strangers and risk and protective characteristics of their social networks. Data were from the Social Network and Homeless Youth Project. A total of 249 youth aged 14-21 years were interviewed over 15 months in three Midwestern cities in the United States using a systematic sampling strategy. Multivariate results revealed that homeless youth with a greater average number of network members who engaged in more drug risk behaviors and who pressured them into precarious behaviors at least once were more likely to have participated in a greater number of HIV risk behaviors with strangers compared to homeless youth without such network characteristics. Additionally, 19-21 year olds, gay, lesbian, bisexual, and transgendered youth, and those who have run away from home more frequently, participated in more HIV risk behaviors with strangers than 14-18 year olds, heterosexual youth, and those who have run away less often. The final model explained 43 % of the variance in homeless youths' HIV risk behaviors with strangers. It is important to identify network characteristics that are harmful to homeless youth because continued exposure to such networks and participation in dangerous behaviors may result in detrimental outcomes, including contraction of sexually transmitted infections and potentially HIV. Siberry, George K; Li, Hong; Jacobson, Denise The objective of this study was to examine the incidence of fractures in HIV-infected children and comparable HIV-exposed, uninfected (HEU) children in a multicenter, prospective cohort study (PACTG 219/219C) in the United States. The main outcome was first fracture during the risk period. Nine fractures occurred in 7 of 1326 HIV-infected and 2 of 649 HEU children, corresponding to incidence rates of 1.2 per 1000 person-years and 1.1 per 1000 person-years, respectively. The incidence rate ratio was 1.1 (95% CI 0.2, 5.5). There was no evidence of a substantially increased risk of fracture in HIV-infected compared to HEU children. Asher, Alice K; Hahn, Judith A; Couture, Marie-Claude; Maher, Kelsey; Page, Kimberly Dramatic rises in injection drug use (IDU) in sub-Saharan Africa account for increasingly more infections in a region already overwhelmed by the HIV epidemic. There is no known estimate of the number of people who inject drugs (PWID) in the region, or the associated HIV prevalence in PWID. We reviewed literature with the goal of describing high-risk practices and exposures in PWID in sub-Saharan Africa, as well as current HIV prevention activities aimed at drug use. The literature search looked for articles related to HIV risk, injection drug users, stigma, and HIV testing in sub-Saharan Africa. This review found evidence demonstrating high rates of HIV in IDU populations in sub-Saharan Africa, high-risk behaviors of the populations, lack of knowledge regarding HIV, and low HIV testing uptake. There is an urgent need for action to address IDU in order to maintain recent decreases in the spread of HIV in sub-Saharan Africa. Copyright © 2013 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved. Katleen de Gaetano Donati Full Text Available In the last 15 years, highly active antiretroviral therapy (HAART has determined a dramatic reduction of both morbidity and mortality in human immunodeficiency virus (HIV-infected subjects, transforming this infection in a chronic and manageable disease. Patients surviving with HIV in the developed world, in larger number men, are becoming aged. As it would be expected for a population of comparable age, many HIV-infected individuals report a family history of cardiovascular disease, a small proportion have already experienced a cardiovascular event and an increasing proportion has diabetes mellitus. Smoking rate is very high while an increasing proportion of HIV-infected individuals have dyslipidaemia. Studies suggest that these traditional risk factors could play an important role in the development of cardiovascular disease in these patients as they do in the general population. Thus, whilst the predicted 10-year cardiovascular disease risk remains relatively low at present, it will likely increase in relation to the progressive aging of this patient population. Thus, the long-term follow-up of HIV infected patients has to include co-morbidity management such as cardiovascular disease prevention and treatment. Two intriguing aspects related to the cardiovascular risk in patients with HIV infection are the matter of current investigation: 1 while these subjects share many cardiovascular risk factors with the general population, HIV infection itself increases cardiovascular risk; 2 some HAART regimens too influence atherosclerotic profile, partly due to lipid changes. Although the mechanisms involved in the development of cardiovascular complications in HIV-infected patients remain to be fully elucidated, treatment guidelines recommending interventions to prevent cardiovascular disease in these individuals are already available; however, their application is still limited. Remien, Robert H; Halkitis, Perry N; O'Leary, Ann; Wolitski, Richard J; Gómez, Cynthia A There are reports of increased sexual risk behavior among people on highly active antiretroviral therapy (HAART) due to beliefs about risk of HIV transmission when on HAART. In a cross-sectional study (Seropositive Urban Men's Study), we examined the relationship between risk perception and sexual risk behavior among sexually active, culturally diverse HIV positive men who have sex with men (N = 456). Less than twenty-five percent engaged in unprotected anal sex (either with an HIV negative, or unknown-status partner, or an HIV positive partner) within the past 3 months. Most men believed there was significant health risk (to partner or self) associated with unprotected sex when on HAART. There was no increased risk behavior associated with being on HAART, although the perception of negative health consequences, including HIV transmission, when on HAART was significantly lower for the relatively small subset of men who reported unprotected sex. Prevention strategies need to be tailored to address risk perception associated with HAART. A cross-sectional study design was used to assess sexual-risk behaviour and HIV-preventive practices among students at Hawassa University, Ethiopia, in 2009. Among 1 220 students eligible for the study, approximately 29% reported experience of sex (36.3% of the males and 9.3% of the females). Of the total sexually ... Nancy A Hessol Full Text Available During the first two decades of the U.S. AIDS epidemic, and unlike some malignancies, breast cancer risk was significantly lower for women with human immunodeficiency virus (HIV infection compared to the general population. This deficit in HIV-associated breast cancer could not be attributed to differences in survival, immune deficiency, childbearing or other breast cancer risk factors. HIV infects mononuclear immune cells by binding to the CD4 molecule and to CCR5 or CXCR4 chemokine coreceptors. Neoplastic breast cells commonly express CXCR4 but not CCR5. In vitro, binding HIV envelope protein to CXCR4 has been shown to induce apoptosis of neoplastic breast cells. Based on these observations, we hypothesized that breast cancer risk would be lower among women with CXCR4-tropic HIV infection.We conducted a breast cancer nested case-control study among women who participated in the WIHS and HERS HIV cohort studies with longitudinally collected risk factor data and plasma. Cases were HIV-infected women (mean age 46 years who had stored plasma collected within 24 months of breast cancer diagnosis and an HIV viral load≥500 copies/mL. Three HIV-infected control women, without breast cancer, were matched to each case based on age and plasma collection date. CXCR4-tropism was determined by a phenotypic tropism assay. Odds ratios (OR and 95% confidence intervals (CI for breast cancer were estimated by exact conditional logistic regression. Two (9% of 23 breast cancer cases had CXCR4-tropic HIV, compared to 19 (28% of 69 matched controls. Breast cancer risk was significantly and independently reduced with CXCR4 tropism (adjusted odds ratio, 0.10, 95% CI 0.002-0.84 and with menopause (adjusted odds ratio, 0.08, 95% CI 0.001-0.83. Adjustment for CD4+ cell count, HIV viral load, and use of antiretroviral therapy did not attenuate the association between infection with CXCR4-tropic HIV and breast cancer.Low breast cancer risk with HIV is specifically linked Salas-Espinoza, Kristian Jesús; Menchaca-Diaz, Rufino; Patterson, Thomas L; Urada, Lianne A; Smith, Davey; Strathdee, Steffanie A; Pitpitan, Eileen V Compared to HIV research on men who have sex with men, less is known about the risks and vulnerabilities for HIV among Male to Female (MTF) transgender persons, particularly in different geographic regions like Mexico. In Tijuana, Mexico, a border city experiencing a dynamic HIV epidemic, no precedent data exists on the MTF transgender population. Our aims were to estimate HIV prevalence and examine the behaviors and characteristics of the population. We conducted a cross-sectional study of 100 MTF transgender persons recruited through time location sampling in 2012. Participants underwent interviewer-administered (paper and pen) surveys and rapid tests for HIV. Descriptive univariate analyses were conducted on various factors, including sociodemographics, substance use, accessing social services (requested vs. received), stigma, and sex behaviors. A total of 22% tested positive for HIV, a prevalence higher than other key populations at risk for HIV in Tijuana. Lee, D; Bell, D C; Hinojosa, M A study was conducted to examine the travel experiences of a community sample of 160 drug users and 44 non-users recruited as part of a study of HIV risk. Of the sample, 47% (96/204) reported intercity travel in the previous ten years. Results showed that men were more likely to travel than women, Anglos more than minorities, and young persons more than old. When travellers testing HIV-seropositive (n = 13) were compared with seronegative travellers, HIV-positive travellers reported more sex while travelling than HIV-negative persons, but virtually all of the difference reported involved sex with condoms. There were no significant differences in sex risk behaviours while travelling between drug users and non-drug users, or in sex risk behaviors between drug injectors and non-injectors. Travellers had fewer injection partners while travelling than they had while at home. There was also a significant difference in number of sex partners with whom a condom was not used, with fewer sex partners while travelling. Huba, GJ; Melchior, LA; Panter, AT; Trevithick, L; Woods, ER; Wright, E; Feudo, R; Tierney, S; Schneir, A; Tenner, A; Remafedi, G; Greenberg, B; Sturdevant, M; Goodman, E; Hodgins, A; Wallace, M; Brady, RE; Singer, B Over 8,000 adolescents and young adults (4,111 males; 4,085 females) reported on several HIV-related risk behaviors during enrollment into 10 service demonstration projects targeted to youth living with, or at risk for, HIV. Distinct risk patterns emerged by gender when predicting HIV serostatus Weissman, Amy; Ngak, Song; Srean, Chhim; Sansothy, Neth; Mills, Stephen; Ferradini, Laurent Introduction Recognizing transgender individuals have a high risk of HIV acquisition, and to inform policies and programming, we conducted an HIV prevalence and risk behaviors survey among transgender individuals in Cambodia. Methods Cross-sectional survey using a respondent driven sampling method with self-administered audio-computer assisted interviews. HIV testing was performed prior to the questionnaire with results available immediately after. Eligible participants were ?18 years, identi... Palma, Anton M; Rabkin, Miriam; Simelane, Samkelo; Gachuhi, Averie B; McNairy, Margaret L; Nuwagaba-Biribonwoha, Harriet; Bongomin, Pido; Okello, Velephi N; Bitchong, Raymond A; El-Sadr, Wafaa M Screening of modifiable cardiovascular disease (CVD) risk factors is recommended but not routinely provided for HIV-infected patients, especially in low-resource settings. Potential concerns include limited staff time and low patient acceptability, but little empirical data exists. As part of a pilot study of screening in a large urban HIV clinic in Swaziland, we conducted a time-motion study to assess the impact of screening on patient flow and HIV service delivery and exit interviews to assess patient acceptability. A convenience sample of patients ≥40 years of age attending routine HIV clinic visits was screened for hypertension, diabetes, hyperlipidemia and tobacco smoking. We observed HIV visits with and without screening and measured time spent on HIV and CVD risk factor screening activities. We compared screened and unscreened patients on total visit time and time spent receiving HIV services using Wilcoxon rank-sum tests. A separate convenience sample of screened patients participated in exit interviews to assess their satisfaction with screening. We observed 172 patient visits (122 with CVD risk factor screening and 50 without). Screening increased total visit time from a median (range) of 4 minutes (2 to 11) to 15 minutes (9 to 30) (p < 0.01). Time spent on HIV care was not affected: 4 (2 to 10) versus 4 (2 to 11) (p = 0.57). We recruited 126 patients for exit interviews, all of whom indicated that they would recommend screening to others. Provision of CVD risk factor screening more than tripled the length of routine HIV clinic visits but did not reduce the time spent on HIV services. Programme managers need to take longer visit duration into account in order to effectively integrate CVD risk factor screening and counselling into HIV programmes. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society. Viani, Rolando M; Araneta, Maria R; Spector, Stephen A To compare HIV prevalence and HIV acquisition risk behaviors between pregnant women residents and migrants. A cross-sectional study of pregnant women of unknown HIV status seeking care at Tijuana General Hospital, Mexico. Pregnant women attending the labor and delivery unit or the prenatal clinic had a rapid HIV test drawn, with positive results confirmed by Western blot. Migrants were defined as women who had resided in Tijuana for less than 5 years. Between 2007 and 2008, a total of 3331 pregnant women consented to participate. The HIV seroprevalence did not differ between Tijuana residents (18 of 2502, 0.72%) and migrants (3 of 829, 0.36%, P = .32). In multivariate regression analyses, HIV acquisition risk behaviors included methamphetamine use (adjusted odds ratio [OR]: 6.03, 95% confidence interval [CI]: 2.3-15.8, P Tijuana residents and migrants. © The Author(s) 2014. Öbrink-Hansen, Kristina; Søgaard, Ole S; Harboe, Zitta B HIV-infected individuals have excess rates of invasive pneumococcal disease. We investigated risk factors for nasopharyngeal pneumococcal colonization at baseline and after 9 months in 96 HIV patients immunized twice with 7- valent pneumococcal conjugate vaccine ±1mg CPG 7909. In total, 22 patients... Adaptation of an HIV behavioural disinhibition risk reduction intervention for ... disinhibition risk reduction interventions for recently circumcised men for use in clinic ... medicine HIV prevention technologies into the male circumcision contexts. Chawarski, Marek C; Vicknasingam, Balasingam; Mazlan, Mahmud; Schottenfeld, Richard S Malaysia has been experiencing significant drug abuse problems since the 1970s, and drug abuse is the major driver of HIV transmission in Malaysia. We investigated risk factors for HIV associated with use of amphetamine type stimulants (ATS) among not-in-treatment opiate injectors in Malaysia. Between October of 2006 and May of 2008, we conducted a series of surveys in three major urban areas of Malaysia. A total of 732 opiate IDUs (679 males and 53 females) were enrolled in the three surveys. The survey instruments consisted of a structured interview on demographic characteristics, drug use history (including year of first use, and past month history of use of illicit drugs; lifetime and past month history of IDU or needle or equipment sharing), and HIV status. There were 194/704 (27.6%) HIV positive participants in the sample. Two factors were significantly associated with HIV infection in this sample: lifetime history of ATS use (OR [95%CI]: 2.3 [1.5-3.6]) and lifetime history of sharing of injection equipment (OR [95% CI]: 4.2 [1.8-9.8]). Both HIV-positive and HIV-negative participants reported high levels of current needle/equipment sharing practices: 82% vs. 75%, respectively. ATS use spread rapidly in the study sample after 1997 and is associated with an increased risk of HIV infection in this population already at high risk because of opiate IDU. Out-of-treatment IDUs in Malaysia engage in high risk behaviors regardless of their HIV status. Increased education and public health prevention measures are needed to reduce HIV transmission risks in this population. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved. Full Text Available Field studies on HIV risk perception suggest that people may rely on impressions they have about the safety of their partner. Previous studies show that individuals perceived as 'risky' regarding HIV elicit a differential brain response in both earlier (~200 - 350 ms and later (~350 - 700 ms time windows compared to those perceived as safe. This raises the question whether this ERP response is specific to contagious life-threatening diseases or a general mechanism triggered by life-threatening but non-contagious diseases. In the present study, we recorded dense sensor EEG while participants (N = 36 evaluated photographs of unacquainted individuals for either HIV or leukemia risk. The ERP results replicated previous findings revealing earlier and later differential brain responses towards individuals perceived as high risk for HIV. However, there were no significant ERP differences for high vs. low leukemia risk. Rather than reflecting a generic response to disease, the present findings suggest that intuitive judgments of HIV risk are at least in part specific to sexually transmitted diseases. Blackstock, Oni J; Frew, Paula; Bota, Dorothy; Vo-Green, Linda; Parker, Kim; Franks, Julie; Hodder, Sally L; Justman, Jessica; Golin, Carol E; Haley, Danielle F; Kuo, Irene; Adimora, Adaora A; Rompalo, Anne; Soto-Torres, Lydia; Wang, Jing; Mannheimer, Sharon B Although studies have consistently demonstrated that women at high risk for HIV and non-HIV sexually transmitted infections (STIs) tend to underestimate their individual risk, little is known about how women at risk perceive their community's HIV/STI risk. We explored perceptions of community HIV/STI risk among U.S. women living in areas with high poverty and HIV prevalence rates as part of a qualitative substudy of the Women's HIV SeroIncidence Study. Semi-structured focus groups were conducted. Data were coded and analyzed using the constant comparative method. Participants expressed the perception that their communities were at elevated HIV/STI risk, mostly due to contextual and structural factors such as lack of access to health care and education. Findings suggest that HIV prevention messages that target U.S. women at high risk for HIV may be strengthened by addressing the high perceived community HIV/STI risk driven by structural factors. Pantelic, Marija; Boyes, Mark; Cluver, Lucie; Meinck, Franziska Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non-adherence to anti-retroviral treatment, loss-to-follow-up and morbidity. This study tested a theoretical model of multi-level risk pathways to internalized HIV stigma among South African ALHIV. From 2013 to 2015, a survey using t otal population sampling of ALHIV who had ever initiated anti-retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community-tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow-up. 90.1% of eligible ALHIV were interviewed ( n = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV-related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well-validated self-report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV-related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV-related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi-level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV Frye, Margaret; Chae, Sophia BACKGROUND Qualitative evidence from sub-Saharan Africa, where a generalized AIDS epidemic exists, suggests that attractiveness may play a role in shaping individual-level HIV risk. Attractive women, who are often blamed for the epidemic and stigmatized, are believed to pose a higher HIV risk because they are viewed as having more and riskier partners. OBJECTIVE We examine the association between perceived attractiveness and HIV infection and risk in rural Malawi in the midst of the country’s severe AIDS epidemic. METHODS We use interviewers’ ratings of respondents’ attractiveness, along with HIV test results and women’s assessments of their own likelihood of infection, to estimate the association between perceived attractiveness and HIV infection and risk for a random sample of 961 women aged 15–35. RESULTS Results show that women who are rated by interviewers as ‘much less’ or ‘less’ attractive than other women their age are 9% more likely to test positive for HIV. We also find that attractiveness is associated with women’s own assessments of their HIV risk: Among women who tested negative, those perceived as ‘much less’ or ‘less’ attractive than average report themselves to be at greater risk of HIV infection. CONCLUSIONS These results suggest that attractiveness is negatively associated with HIV risk in Malawi, countering local beliefs that hold attractive women responsible for perpetuating the epidemic. CONTRIBUTION This study highlights the need to consider perceived physical attractiveness, and sexual desirability more broadly, as an under-examined axis of inequality in HIV risk in high-prevalence settings. PMID:29242708 MUGO, Nelly R.; HEFFRON, Renee; DONNELL, Deborah; WALD, Anna; WERE, Edwin O.; REES, Helen; CELUM, Connie; KIARIE, James N.; COHEN, Craig R.; KAYINTEKORE, Kayitesi; BAETEN, Jared M. Background Physiologic and behavioral changes during pregnancy may alter HIV-1 susceptibility and infectiousness. Prospective studies exploring pregnancy and HIV-1 acquisition risk in women have found inconsistent results. No study has explored the effect of pregnancy on HIV-1 transmission risk from HIV-1 infected women to male partners. Methods In a prospective study of African HIV-1 serodiscordant couples, we evaluated the relationship between pregnancy and the risk of 1) HIV-1 acquisition among women and 2) HIV-1 transmission from women to men. Results 3321 HIV-1 serodiscordant couples were enrolled, 1085 (32.7%) with HIV-1 susceptible female partners and 2236 (67.3%) with susceptible male partners. HIV-1 incidence in women was 7.35 versus 3.01 per 100 person-years during pregnant and non-pregnant periods (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.33–4.09). This effect was attenuated and not statistically significant after adjusting for sexual behavior and other confounding factors (adjusted HR 1.71, 95% CI 0.93–3.12). HIV-1 incidence in male partners of infected women was 3.46 versus 1.58 per 100 person-years when their partners were pregnant versus not pregnant (HR 2.31, 95% CI 1.22–4.39). This effect was not attenuated in adjusted analysis (adjusted HR 2.47, 95% CI 1.26–4.85). Conclusions HIV-1 risk increased two-fold during pregnancy. Elevated risk of HIV-1 acquisition in pregnant women appeared in part to be explained by behavioral and other factors. This is the first study to show pregnancy increased the risk of female-to-male HIV-1 transmission, which may reflect biological changes of pregnancy that could increase HIV-1 infectiousness. PMID:21785321 Marbaniang, Ivan P; Kadam, Dileep; Suman, Rohan; Gupte, Nikhil; Salvi, Sonali; Patil, Sandesh; Shere, Dhananjay; Deshpande, Prasad; Kulkarni, Vandana; Deluca, Andrea; Gupta, Amita; Mave, Vidya To characterise prevalence of traditional cardiovascular disease (CVD) risk factors, assess CVD risk and examine the effect of simulated interventions on CVD risk among HIV-infected Asian Indians. Cross-sectional data between September 2015 and July 2016 wer used to describe the prevalence of CVD risk factors. Five risk scores (Framingham, Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D), Atherosclerotic Cardiovascular, QRISK2 and Ramathibodi-Electricity Generating Authority of Thailand were used to estimate CVD risk. The effect of seven sensitivity analyses: smoking prevention; diabetes prevention; optimal blood pressure and dyslipidaemia control (total cholesterol, high-density lipoprotein (HDL)); CD4 augmentation and a combination of the scenarios on the median cumulative D:A:D CVD scores were assessed. Of 402 enrolled, 56% were women, median age was 40 years (IQR: 35-45 years) and median time-updated CD4 counts were 378 cells/μL (IQR: 246-622). Fifty-five and 28% had ever been screened for hypertension and diabetes, respectively prior to enrolment. The prevalence of diabetes, hypertension, hypercholesterolaemia, low HDL, previous and current smokers were 9%, 22%, 20%, 39%, 14% and 4%, respectively. Thirty-six per cent had intermediate-to-high 5-year CVD risk by D:A:D estimates. Thirty-two per cent were eligible for statin therapy by American College of Cardiology/American Heart Association guidelines; 2% were currently on statins. In sensitivity analyses, diabetes prevention was associated with the highest reduction of CVD risk. CVD at younger ages among Asian Indian people living with HIV appear to be an imminent risk for morbidity. Stepping up of preventive services including screening services and prescription of statins are important strategies that must be considered. Borges, Álvaro H; Silverberg, Michael J; Wentworth, Deborah To investigate the relationship between inflammatory [interleukin-6 (IL-6) and C-reactive protein (CRP)] and coagulation (D-dimer) biomarkers and cancer risk during HIV infection.......To investigate the relationship between inflammatory [interleukin-6 (IL-6) and C-reactive protein (CRP)] and coagulation (D-dimer) biomarkers and cancer risk during HIV infection.... Blackstock, Oni J.; Frew, Paula; Bota, Dorothy; Vo-Green, Linda; Parker, Kim; Franks, Julie; Hodder, Sally L.; Justman, Jessica; Golin, Carol E.; Haley, Danielle F.; Kuo, Irene; Adimora, Adaora A.; Rompalo, Anne; Soto-Torres, Lydia; Wang, Jing Although studies have consistently demonstrated that women at high risk for HIV and non-HIV sexually transmitted infections (STIs) tend to underestimate their individual risk, little is known about how women at risk perceive their community’s HIV/STI risk. We explored perceptions of community HIV/ STI risk among U.S. women living in areas with high poverty and HIV prevalence rates as part of a qualitative substudy of the Women’s HIV SeroIncidence Study. Semi-structured focus groups were condu... Eileen V Pitpitan Full Text Available Women in South Africa are at particularly high-risk for HIV infection and are dependent on their male partners' use of condoms for sexual risk reduction. However, many women are afraid to discuss condoms with male partners, placing them at higher risk of HIV infection.To examine the association between fear of condom negotiation with HIV testing and transmission risk behaviors, including alcohol use and sexual risks among South African women.Women (N = 1333 residing in a primarily Xhosa-speaking African township in Cape Town and attending informal alcohol-serving venues (shebeens completed anonymous surveys. Logistic regression was used to test the hypothesis that fear of condom negotiation would be associated with increased risk for HIV.Compared to women who did not fear condom negotiation, those who did were significantly less likely to have been tested for HIV, were more likely to have experienced relationship abuse, and to report more alcohol use and more unprotected sex.For women in South Africa, fear of condom negotiation is related to higher risk of HIV. HIV prevention efforts, including targeted HIV counseling and testing, must directly address gender issues. Full Text Available Abstract Background Lower-than-expected incidence of HIV undermines sample size calculations and compromises the power of a HIV prevention trial. We evaluated the effectiveness of interim monitoring of HIV infection rates and on-going modification of recruitment strategies to enroll women at higher risk of HIV in the Cellulose Sulfate Phase III study in Nigeria. Methods We analyzed prevalence and incidence of HIV and other sexually transmitted infections, demographic and sexual behavior characteristics aggregated over the treatment groups on a quarterly basis. The site investigators were advised on their recruitment strategies based on the findings of the interim analyses. Results A total of 3619 women were screened and 1644 enrolled at the Ikeja and Apapa clinics in Lagos, and at the Central and Peripheral clinics in Port Harcourt. Twelve months after study initiation, the overall incidence of HIV was less than one-third of the pre-study assumption, with rates of HIV that varied substantially between clinics. Due to the low prevalence and incidence rates of HIV, it was decided to close the Ikeja clinic in Lagos and to find new catchment areas in Port Harcourt. This strategy was associated with an almost two-fold increase in observed HIV incidence during the second year of the study. Conclusion Given the difficulties in estimating HIV incidence, a close monitoring of HIV prevalence and incidence rates during a trial is warranted. The on-going modification of recruitment strategies based on the regular analysis of HIV rates appeared to be an efficient method for targeting populations at greatest risk of HIV infection and increasing study power in the Nigeria trial. Trial Registration The trial was registered with the ClinicalTrials.gov registry under #NCT00120770 http://clinicaltrials.gov/ct2/show/NCT00120770 Kiene, Susan M.; Fisher, William A.; Shuper, Paul A.; Cornman, Deborah H.; Christie, Sarah; MacDonald, Susan; Pillay, Sandy; Mahlase, Gethwana; Fisher, Jeffrey D. The current study applied the Information—Motivation—Behavioral Skills (IMB) model (J. D. Fisher & Fisher, 1992; W. A. Fisher & Fisher, 1993) to identify factors associated with HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy (ART), a population of considerable significance for curtailing, or maintaining, South Africa’s generalized HIV epidemic. HIV prevention information, HIV prevention motivation, HIV prevention behavioral skills, and HIV transmission risk behavior were assessed in a sample of 1,388 South Africans infected with HIV and receiving ART in 16 clinics in KwaZulu-Natal, South Africa. Results confirmed the assumptions of the IMB model and demonstrated that HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV transmission risk behavior in this population. Subanalyses confirmed these relationships for HIV transmission risk behavior overall and for HIV transmission risk behavior with partners perceived to be HIV-negative or HIV-status unknown. A consistent pattern of gender differences showed that for men, HIV prevention information and HIV prevention motivation may have direct links with HIV preventive behavior, while for women, the effects of HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV preventive behavior. These IMB model-based findings suggest directions for HIV prevention interventions with South African men and women living with HIV and on ART as an important component of overall strategies to contain South Africa’s generalized HIV epidemic. PMID:23477576 Full Text Available Elizabeth Gori,1,2 Takafira Mduluza,3,4 Mudavanhu Nyagura,2 Babill Stray-Pedersen,5 Zvenyika Alfred Gomo1 1Chemical Pathology Department, College of Health Sciences, 2Preclinical Veterinary Studies Department, Faculty of Veterinary Sciences, 3Biochemistry Department, University of Zimbabwe, Harare, Zimbabwe; 4School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; 5Institute of Clinical Medicine, University in Oslo, Oslo University Hospital, Oslo, Norway Abstract: HIV infection and antiretroviral therapy (ART are associated with changes in plasma levels of lipoproteins, thus posing the risk of cardiovascular complications in infected individuals. The alteration in plasma lipoprotein levels results from dysregulation of inflammation-modulating cytokines that control lipid metabolism. Little is understood regarding the relationship between the cytokines and serum lipid levels, which have been reported to be altered in adults receiving ART. The objective of this study was to describe the profiles of inflammation-modulating cytokines and their relationship to lipids as cardiovascular disease (CVD risk factors in HIV infection. This observational cross-sectional study measured plasma levels of interleukin (IL-10, tumor necrosis factor-alpha (TNF-α, IL-4, total cholesterol (TC, and high-density lipoprotein cholesterol (HDL-c in HIV-infected and uninfected adults. A total of 219 HIV-infected participants were enrolled from an HIV treatment center; of them, 187 were receiving ART and 32 were ART naïve, while 65 were HIV-uninfected blood donors. HIV-infected individuals had higher levels of IL-10 (HIV-infected ART-naïve [P=0.0024] and ART-receiving [P=0.033] than their uninfected counterparts. ART-naïve subjects had significantly higher plasma levels of IL-10 than ART-receiving subjects (P=0.0014. No significant difference was observed in plasma levels of IL-4 and TNF Kiene, Susan M; Fisher, William A; Shuper, Paul A; Cornman, Deborah H; Christie, Sarah; Macdonald, Susan; Pillay, Sandy; Mahlase, Gethwana; Fisher, Jeffrey D The current study applied the Information-Motivation-Behavioral Skills (IMB) model (Fisher & Fisher, 1992; Fisher & Fisher, 1993) to identify factors associated with human immunodeficiency virus (HIV) transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy (ART), a population of considerable significance for curtailing, or maintaining, South Africa's generalized HIV epidemic. HIV prevention information, HIV prevention motivation, HIV prevention behavioral skills, and HIV transmission risk behavior were assessed in a sample of 1,388 South Africans infected with HIV and receiving ART in 16 clinics in KwaZulu-Natal, South Africa. Findings confirmed the assumptions of the IMB model and demonstrated that HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV transmission risk behavior in this population. Subanalyses confirmed these relationships for HIV transmission risk behavior overall and for HIV transmission risk behavior with partners perceived to be HIV-negative or HIV-status unknown. A consistent pattern of gender differences showed that for men, HIV prevention information and HIV prevention motivation may have direct links with HIV preventive behavior, whereas for women, the effect of HIV prevention motivation works through HIV prevention behavioral skills to affect HIV preventive behavior. These IMB model-based findings suggest directions for HIV prevention interventions with South African men and women living with HIV and on ART as an important component of overall strategies to contain South Africa's generalized HIV epidemic. PsycINFO Database Record (c) 2013 APA, all rights reserved. Reid, Stewart E; Dai, James Y; Wang, Jing; Sichalwe, Bupe N; Akpomiemie, Godspower; Cowan, Frances M; Delany-Moretlwe, Sinead; Baeten, Jared M; Hughes, James P; Wald, Anna; Celum, Connie Biomedical HIV prevention trials enroll sexually active women at risk of HIV and often discontinue study product during pregnancy. We assessed risk factors for pregnancy and HIV acquisition, and the effect of pregnancy on time off study drug in HIV Prevention Trials Network 039. A total of 1358 HIV negative, herpes simplex virus type 2-seropositive women from South Africa, Zambia, and Zimbabwe were enrolled and followed for up to 18 months. A total of 228 pregnancies occurred; time off study drug due to pregnancy accounted for 4% of woman-years of follow-up among women. Being pregnant was not associated with increased HIV risk (hazard ratio 0.64, 95% confidence interval 0.23-1.80, P = 0.40). However, younger age was associated with increased risk for both pregnancy and HIV. There was no association between condom use as a sole contraceptive and reduced pregnancy incidence; hormonal contraception was not associated with increased HIV risk. Bacterial vaginosis at study entry was associated with increased HIV risk (hazard ratio 2.03, P = 0.02). Pregnancy resulted in only a small amount of woman-time off study drug. Young women are at high risk for HIV and are an appropriate population for HIV prevention trials but also have higher risk of pregnancy. Condom use was not associated with reduced incidence of pregnancy. Roman Isler, M; Golin, C; Wang, J; Hughes, J; Justman, J; Haley, D; Kuo, I; Adimora, A; Chege, W; Hodder, S Identifying venues where women meet sexual partners, particular partners who increase women's risk of acquiring HIV, could inform prevention efforts. We categorized venues where women enrolled in HPTN 064 reported meeting their last three sex partners as: (1) Formal, (2) Public, (3) Private, and (4) Virtual spaces. We used multinomial logistic regression to assess the association between these venues and women's individual characteristics and reports of their partners' HIV risk characteristics. The 2099 women reported meeting 3991 partners, 51 % at Public, 30 % Private, 17 % Formal and 3 % at Virtual venues. Women meeting partners at Formal venues reported more education and condom use than women meeting partners at other venues. Fewer partners met through Formal venues had "high" risk characteristics for HIV than through other venues and hence may pose less risk of HIV transmission. HIV prevention interventions can help women choose partners with fewer risk characteristics across all venue types. Mohamed A Daw Full Text Available In 1998 Libya experienced a major outbreak of multiple blood borne viral hepatitis and HIV infections. Since then, no studies have been done on the epidemic features and risk factors of HBV, HCV, HIV and co-infection among the general population.A prospective study was carried out using a multi-centre clustering method to collect samples from the general population. The participants were interviewed, and relevant information was collected, including socio-demographic, ethnic, and geographic variables. This information was correlated with the risk factors involved in the transmission of HBV, HCV and HIV. Blood samples were collected and the sera were tested for HBsAg, anti-HCV and anti-HIV using enzyme immunoassay.A total of 9,170 participants from the nine districts of Tripoli were enrolled. The average prevalence of HBsAg was 3.7%, anti-HCV 0.9%, anti-HIV 0.15% and co-infection 0.02%. The prevalence varied from one district to another. HBV was more prevalent among those aged over 50 years and was associated with family history. Anti-HCV and anti-HIV were more prevalent among those aged 20-40 years. Intravenous drug use and blood transfusion were the main risk factors for HCV and HIV infection.HBV, HCV, HIV and co-infection are relatively common in Libya. High prevalence was associated with geographic, ethnic and socioeconomic variability within the community. HCV and HIV infections among the younger age groups are becoming an alarming issue. Regulations and health care education need to be implemented and longer term follow-up should be planned. O'Connell, Ann A; Reed, Sandra J; Serovich, Julianne A Interventions to assist HIV+ persons in disclosing their serostatus to sexual partners can play an important role in curbing rates of HIV transmission among men who have sex with men (MSM). Based on the methods of Pinkerton and Galletly (AIDS Behav 11:698-705, 2007), we develop a mathematical probability model for evaluating effectiveness of serostatus disclosure in reducing the risk of HIV transmission and extend the model to examine the impact of serosorting. In baseline data from 164 HIV+ MSM participating in a randomized controlled trial of a disclosure intervention, disclosure is associated with a 45.0 % reduction in the risk of HIV transmission. Accounting for serosorting, a 61.2 % reduction in risk due to disclosure was observed in serodisconcordant couples. The reduction in risk for seroconcordant couples was 38.4 %. Evidence provided supports the value of serostatus disclosure as a risk reduction strategy in HIV+ MSM. Interventions to increase serostatus disclosure and that address serosorting behaviors are needed. Peter M Janiszewski Full Text Available Although half of HIV-infected patients develop lipodystrophy and metabolic complications, there exists no simple clinical screening tool to discern the high from the low-risk HIV-infected patient. Thus, we evaluated the associations between waist circumference (WC combined with triglyceride (TG levels and the severity of lipodystrophy and cardiovascular risk among HIV-infected men and women.1481 HIV-infected men and 841 HIV-infected women were recruited between 2005 and 2009 at the metabolic clinic of the University of Modena and Reggio Emilia in Italy. Within each gender, patients were categorized into 4 groups according to WC and TG levels. Total and regional fat and fat-free mass were assessed by duel-energy x-ray absorptiometry, and visceral adipose tissue (VAT and abdominal subcutaneous AT (SAT were quantified by computed tomography. Various cardiovascular risk factors were assessed in clinic after an overnight fast.The high TG/high WC men had the most VAT (208.0 ± 94.4 cm(2, as well as the highest prevalence of metabolic syndrome (42.2% and type-2 diabetes (16.2%, and the highest Framingham risk score (10.3 ± 6.5 in comparison to other groups (p<0.05 for all. High TG/high WC women also had elevated VAT (150.0 ± 97.9 cm(2 and a higher prevalence of metabolic syndrome (53.3%, hypertension (30.5% and type-2 diabetes (12.0%, and Framingham risk score(2.9 ± 2.8 by comparison to low TG/low WC women (p<0.05 for all.A simple tool combining WC and TG levels can discriminate high- from low-risk HIV-infected patients. Janiszewski, Peter M.; Ross, Robert; Despres, Jean-Pierre; Lemieux, Isabelle; Orlando, Gabriella; Carli, Federica; Bagni, Pietro; Menozzi, Marianna; Zona, Stefano; Guaraldi, Giovanni Background Although half of HIV-infected patients develop lipodystrophy and metabolic complications, there exists no simple clinical screening tool to discern the high from the low-risk HIV-infected patient. Thus, we evaluated the associations between waist circumference (WC) combined with triglyceride (TG) levels and the severity of lipodystrophy and cardiovascular risk among HIV-infected men and women. Methods 1481 HIV-infected men and 841 HIV-infected women were recruited between 2005 and 2009 at the metabolic clinic of the University of Modena and Reggio Emilia in Italy. Within each gender, patients were categorized into 4 groups according to WC and TG levels. Total and regional fat and fat-free mass were assessed by duel-energy x-ray absorptiometry, and visceral adipose tissue (VAT) and abdominal subcutaneous AT (SAT) were quantified by computed tomography. Various cardiovascular risk factors were assessed in clinic after an overnight fast. Results The high TG/high WC men had the most VAT (208.0±94.4 cm2), as well as the highest prevalence of metabolic syndrome (42.2%) and type-2 diabetes (16.2%), and the highest Framingham risk score (10.3±6.5) in comparison to other groups (p<0.05 for all). High TG/high WC women also had elevated VAT (150.0±97.9 cm2) and a higher prevalence of metabolic syndrome (53.3%), hypertension (30.5%) and type-2 diabetes (12.0%), and Framingham risk score(2.9±2.8) by comparison to low TG/low WC women (p<0.05 for all). Conclusions A simple tool combining WC and TG levels can discriminate high- from low-risk HIV-infected patients. PMID:21966404 Wilbert Sibanda; Philip Pretorius This research paper covers the development of an HIV risk scorecard using SAS Enterprise MinerTM. The HIV risk scorecard was developed using the 2007 South African annual antenatal HIV and syphilis seroprevalence data. Limited comparisons are made with a more recent 2010 antenatal database. Antenatal data contains various demographic characteristics for each pregnant woman, such as pregnant woman’s age, male sexual partner’s age, population group, level of education, gravidity, parity, HIV an... Baral, Stefan; Logie, Carmen H; Grosso, Ashley; Wirtz, Andrea L; Beyrer, Chris Social and structural factors are now well accepted as determinants of HIV vulnerabilities. These factors are representative of social, economic, organizational and political inequities. Associated with an improved understanding of multiple levels of HIV risk has been the recognition of the need to implement multi-level HIV prevention strategies. Prevention sciences research and programming aiming to decrease HIV incidence requires epidemiologic studies to collect data on multiple levels of risk to inform combination HIV prevention packages. Proximal individual-level risks, such as sharing injection devices and unprotected penile-vaginal or penile-anal sex, are necessary in mediating HIV acquisition and transmission. However, higher order social and structural-level risks can facilitate or reduce HIV transmission on population levels. Data characterizing these risks is often far more actionable than characterizing individual-level risks. We propose a modified social ecological model (MSEM) to help visualize multi-level domains of HIV infection risks and guide the development of epidemiologic HIV studies. Such a model may inform research in epidemiology and prevention sciences, particularly for key populations including men who have sex with men (MSM), people who inject drugs (PID), and sex workers. The MSEM builds on existing frameworks by examining multi-level risk contexts for HIV infection and situating individual HIV infection risks within wider network, community, and public policy contexts as well as epidemic stage. The utility of the MSEM is demonstrated with case studies of HIV risk among PID and MSM. The MSEM is a flexible model for guiding epidemiologic studies among key populations at risk for HIV in diverse sociocultural contexts. Successful HIV prevention strategies for key populations require effective integration of evidence-based biomedical, behavioral, and structural interventions. While the focus of epidemiologic studies has traditionally been on Cluver, Lucie Dale; Orkin, Frederick Mark; Meinck, Franziska; Boyes, Mark Edward; Sherr, Lorraine Social protection is high on the HIV-prevention agenda for youth in sub-Saharan Africa. However, questions remain: How do unconditional cash transfers work? What is the effect of augmenting cash provision with social care? And can "cash plus care" social protection reduce risks for adolescents most vulnerable to infection? This study tackles these questions by first identifying mediated pathways to adolescent HIV risks and then examining potential main and moderating effects of social protection in South Africa. This study was a prospective observational study of 3515 10-to-17-year-olds (56.7% female; 96.8% one-year retention). Within randomly selected census areas in four rural and urban districts in two South African provinces, all homes with a resident adolescent were sampled between 2009/2010 and 2011/2012. Measures included 1) potential structural drivers of HIV infection such as poverty and community violence; 2) HIV risk behaviours; 3) hypothesized psychosocial mediating factors; and 4) types of social protection involving cash and care. Using gender-disaggregated analyses, longitudinal mediation models were tested for potential main and moderating effects of social protection. Structural drivers were associated with increased onset of adolescent HIV risk behaviour (psocial protection were associated with reductions in HIV risk behaviour and psychosocial deprivations. In addition, cash social protection moderated risk pathways: for adolescent girls and boys experiencing more acute structural deprivation, social protection had the greatest associations with HIV risk prevention (e.g. moderation effects for girls: B=-0.08, psocial protection has the greatest prevention effects for the most vulnerable. Social protection comprising unconditional cash plus care was associated with reduced risk pathways through moderation and main effects, respectively. Our findings suggest the importance of social protection within a combination package of HIV Wilbert Sibanda; Philip Pretorius This research paper covers the development of an HIV risk scorecard using SAS Enterprise MinerTM. The HIV risk scorecard was developed using the 2007 South African annual antenatal HIV and syphilis seroprevalence data. Antenatal data contains various demographic characteristics for each pregnant woman, such as pregnant woman's age, male sexual partner's age, race, level of education, gravidity, parity, HIV and syphilis status. The purpose of this research was to use a scorecard to rank the ef... Full Text Available Previous studies of HIV acquisition in pregnancy have been in specific population groups, such as sero-discordant couples which have shown an increased risk of HIV acquisition during pregnancy and studies of sexually active women where the results have been ambiguous. However these studies are unable to tell us what the overall impact of pregnancy is on HIV acquisition in the general population.Data from six community-based HIV cohorts were pooled to give 2,628 sero-conversions and a total of 178,000 person years of observation. Multiple imputation was used to allow for the uncertainty of exact sero-conversion date in surveillance intervals greater than the length of a pregnancy. Results were combined using Rubin's rules to give appropriate error bounds. The analysis was stratified into two periods: pre- and post- widespread availability of prevention of mother-to-child HIV transmission services. This allows us to assess whether there is reporting bias relating to a person's knowledge of their own HIV status which would become more widespread in the latter time period.Results suggest that women while pregnant have a lower risk of acquiring HIV infection over all periods (HRR 0.79, 95%CI 0.70-0.89 than women who were not pregnant. There is no evidence for a difference in the rate of HIV acquisition between postpartum and non-pregnant women (HRR 0.92 95%CI 0.84-1.03.Although there may be immunological reasons for increased risk of HIV acquisition during pregnancy, at a population level this study indicates a lower risk of HIV acquisition for pregnant women. Pregnant women may be more likely to be concordant with their current sexual partner than non-pregnant women, i.e. either already HIV positive prior to the pregnancy or if negative at the time of becoming pregnant more likely to have a negative partner. Panda, Samiran; Kumar, M Suresh; Lokabiraman, S; Jayashree, K; Satagopan, M C; Solomon, Suniti; Rao, Usha Anand; Rangaiyan, Gurumurthy; Flessenkaemper, Sabine; Grosskurth, Heiner; Gupte, Mohan D Determining HIV prevalence in injection drug users (IDUs) and their regular sex partners in Chennai, India. A total of 226 IDUs and their regular sex partners were enrolled during April-July 2003. After informed consent was obtained, a semistructured questionnaire was administered and serum was tested for HIV antibody. The HIV seroprevalence was 30% (68/226) in IDUs and 5% in their regular sex partners (11/226). While in 25% of couples only the male partner was HIV positive, 5% of the couples were concordant for HIV infection and 70% were HIV negative. Fifty-seven percent of the HIV-positive IDUs and 45% of the HIV-infected women thought that they had "no chance" or "very little chance" of getting HIV, reflecting low HIV risk perception. More than 20% IDUs reported borrowing or lending of injection equipment. In univariate analyses "sex" and "condom use" with sex workers had no bearing but "more than twice a day injecting frequency," "history of incarceration," "tattoos," "recruitment from northern part of the city," and ever-injecting drugs in drug-selling places had significant association with HIV infection in IDUs. In an adjusted model, the odds of HIV infection were 2 times higher among IDUs who had ever injected drugs in drug-selling places and 6 times higher in those who were recruited from the northern part of central Chennai. Reducing sharing of injection equipment and unsafe tattooing through targeted and environmental interventions, increasing HIV risk perception, and promoting safer sex practices among IDUs and their sex partners are urgent program needs. Cindy M. Liu Full Text Available Sexual transmission of HIV requires exposure to the virus and infection of activated mucosal immune cells, specifically CD4+ T cells or dendritic cells. The foreskin is a major site of viral entry in heterosexual transmission of HIV. Although the probability of acquiring HIV from a sexual encounter is low, the risk varies even after adjusting for known HIV risk factors. The genital microbiome may account for some of the variability in risk by interacting with the host immune system to trigger inflammatory responses that mediate the infection of mucosal immune cells. We conducted a case-control study of uncircumcised participants nested within a randomized-controlled trial of male circumcision in Rakai, Uganda. Using penile (coronal sulcus swabs collected by study personnel at trial enrollment, we characterized the penile microbiome by sequencing and real-time PCR and cytokine levels by electrochemiluminescence assays. The absolute abundances of penile anaerobes at enrollment were associated with later risk of HIV seroconversion, with a 10-fold increase in Prevotella, Dialister, Finegoldia, and Peptoniphilus increasing the odds of HIV acquisition by 54 to 63%, after controlling for other known HIV risk factors. Increased abundances of anaerobic bacteria were also correlated with increased cytokines, including interleukin-8, which can trigger an inflammatory response that recruits susceptible immune cells, suggesting a mechanism underlying the increased risk. These same anaerobic genera can be shared between heterosexual partners and are associated with increased HIV acquisition in women, pointing to anaerobic dysbiosis in the genital microbiome and an accompanying inflammatory response as a novel, independent, and transmissible risk factor for HIV infection. Cardiovascular risk prediction in HIV-infected patients: comparing the Framingham, atherosclerotic cardiovascular disease risk score (ASCVD), Systematic Coronary Risk Evaluation for the Netherlands (SCORE-NL) and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) risk prediction models. Krikke, M; Hoogeveen, R C; Hoepelman, A I M; Visseren, F L J; Arends, J E The aim of the study was to compare the predictions of five popular cardiovascular disease (CVD) risk prediction models, namely the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) model, the Framingham Heart Study (FHS) coronary heart disease (FHS-CHD) and general CVD (FHS-CVD) models, the American Heart Association (AHA) atherosclerotic cardiovascular disease risk score (ASCVD) model and the Systematic Coronary Risk Evaluation for the Netherlands (SCORE-NL) model. A cross-sectional design was used to compare the cumulative CVD risk predictions of the models. Furthermore, the predictions of the general CVD models were compared with those of the HIV-specific D:A:D model using three categories ( 20%) to categorize the risk and to determine the degree to which patients were categorized similarly or in a higher/lower category. A total of 997 HIV-infected patients were included in the study: 81% were male and they had a median age of 46 [interquartile range (IQR) 40-52] years, a known duration of HIV infection of 6.8 (IQR 3.7-10.9) years, and a median time on ART of 6.4 (IQR 3.0-11.5) years. The D:A:D, ASCVD and SCORE-NL models gave a lower cumulative CVD risk, compared with that of the FHS-CVD and FHS-CHD models. Comparing the general CVD models with the D:A:D model, the FHS-CVD and FHS-CHD models only classified 65% and 79% of patients, respectively, in the same category as did the D:A:D model. However, for the ASCVD and SCORE-NL models, this percentage was 89% and 87%, respectively. Furthermore, FHS-CVD and FHS-CHD attributed a higher CVD risk to 33% and 16% of patients, respectively, while this percentage was D:A:D, ASCVD and SCORE-NL models. This could have consequences regarding overtreatment, drug-related adverse events and drug-drug interactions. © 2015 British HIV Association. Bailey, Ajay; Hutter, Inge Behaviour change models in HIV prevention tend to consider that risky sexual behaviours reflect risk assessments and that by changing risk assessments behaviour can be changed. Risk assessment is however culturally constructed. Individuals use heuristics or bounded cognitive devices derived from broader cultural meaning systems to rationalize uncertainty. In this study, we identify some of the cultural heuristics used by migrant men in Goa, India to assess their risk of HIV infection from different sexual partners. Data derives from a series of in-depth interviews and a locally informed survey. Cultural heuristics identified include visual heuristics, heuristics of gender roles, vigilance and trust. The paper argues that, for more culturally informed HIV/AIDS behaviour change interventions, knowledge of cultural heuristics is essential. Smith, Rachel A; Morrison, Daniel People often perceive risks for others and themselves differently. This study examines whether personal beliefs about HIV and experience with those living with HIV influence personal risk assessments of contracting HIV in an interview sample of northern Namibians (N=400), but not others' assessments as explained by singular-distribution theory [Klar, Medding, & Sarel (1996). Nonunique invulnerability: Singular versus distributional probabilities and unrealistic optimism in comparative risk judgments. Organizational Behavior and Human Decision Processes, 67, 229-245]. Findings indicate that personal risk perceptions decrease with more HIV stigmatizing beliefs and increase with greater experience, but that those characteristics had no impact on assessments for others' risk. The study also examines whether the size and characteristics of the referent group, peers and the general Namibian population, influence others' risk assessments. Optimistic biases for personal risk versus others' risk appear with the highest discrepancy emerging between personal and general population risk assessments. Further, we found that personal risk perceptions did not mediate the relationship between personal characteristics, beliefs and experiences, and intentions to seek HIV testing. Daw, Mohamed A.; Shabash, Amira; El-Bouzedi, Abdallah; Dau, Aghnya A. Background In 1998 Libya experienced a major outbreak of multiple blood borne viral hepatitis and HIV infections. Since then, no studies have been done on the epidemic features and risk factors of HBV, HCV, HIV and co-infection among the general population. Methods A prospective study was carried out using a multi-centre clustering method to collect samples from the general population. The participants were interviewed, and relevant information was collected, including socio-demographic, ethnic, and geographic variables. This information was correlated with the risk factors involved in the transmission of HBV, HCV and HIV. Blood samples were collected and the sera were tested for HBsAg, anti-HCV and anti-HIV using enzyme immunoassay. Results A total of 9,170 participants from the nine districts of Tripoli were enrolled. The average prevalence of HBsAg was 3.7%, anti-HCV 0.9%, anti-HIV 0.15% and co-infection 0.02%. The prevalence varied from one district to another. HBV was more prevalent among those aged over 50 years and was associated with family history. Anti-HCV and anti-HIV were more prevalent among those aged 20–40 years. Intravenous drug use and blood transfusion were the main risk factors for HCV and HIV infection. Conclusion HBV, HCV, HIV and co-infection are relatively common in Libya. High prevalence was associated with geographic, ethnic and socioeconomic variability within the community. HCV and HIV infections among the younger age groups are becoming an alarming issue. Regulations and health care education need to be implemented and longer term follow-up should be planned. PMID:24936655 The aim of this study is to investigate HIV knowledge, beliefs and HIV risk behaviours among ex-offenders in Mpumalanga province, South Africa. A sample of 85 male ex-offenders conveniently selected from an exoffenders organization were interviewed with a structured and open-ended questionnaire. Results indicate ... High risk sexual behaviour, alcohol and drug use, and mental health problems combine to yield high levels of HIV-risk behaviour among adolescents with mental health problems. In South Africa, little research has been conducted on parental perspectives of HIV-risk among this population. We conducted a series of focus ... Thomson, Kerry A; Hughes, James; Baeten, Jared M; John-Stewart, Grace; Celum, Connie; Cohen, Craig R; Ngure, Kenneth; Kiarie, James; Mugo, Nelly; Heffron, Renee Understanding the absolute and relative risk of HIV-1 acquisition during pregnancy and postpartum can inform HIV-1 prevention strategies for women. We used a complementary log-log model and data from 2,751 HIV-1 serodiscordant couples to compare the probability of women's HIV-1 acquisition risk per sex act during early pregnancy, late pregnancy, postpartum, and non-pregnant periods. At total of 686 pregnancies were identified and 82 incident HIV-1 infections occurred. After adjustment for condom use, age, PrEP use, and HIV-1 viral load, the per act probability of HIV-1 acquisition was higher in late pregnancy (aRR 2.82, p=0.01) and postpartum (aRR 3.97, p=0.01) compared to non-pregnant periods. The HIV-1 acquisition probability per condomless sex act for a 25 year old woman not taking PrEP with an HIV-1 infected male partner with viral load of 10,000 copies/ml was 0.0011 (95% CI: 0.005, 0.0019), 0.0022 (95% CI: 0.0004, 0.0093), 0.0030 (95% CI: 0.0007, 0.0108), and 0.0042 (95% CI: 0.0007, 0.0177) in the non-pregnant, early pregnant, late pregnant, and postpartum periods, respectively. The HIV-1 acquisition probability per condomless sex act steadily increased through pregnancy and was highest during the postpartum period, suggesting that biological changes during pregnancy and postpartum increase female HIV-1 susceptibility. Martin-Iguacel, R; Llibre, J M; Friis-Moller, N With more effective and widespread antiretroviral treatment, the overall incidence of AIDS- or HIV-related death has decreased dramatically. Consequently, as patients are aging, cardiovascular disease (CVD) has emerged as an important cause of morbidity and mortality in the HIV population....... The incidence of CVD overall in HIV is relatively low, but it is approximately 1.5-2-fold higher than that seen in age-matched HIV-uninfected individuals. Multiple factors are believed to explain this excess in risk such as overrepresentation of traditional cardiovascular risk factors (particularly smoking... Biruck Desalegn * firstname.lastname@example.org, Hunachew Beyene & Ryo Yamada Aug 20, 2012 ... Keywords: risk of HIV transmission, healthcare workers, Hawassa City. Résumé ... Journal des Aspects Sociaux du VIH/SIDA. 1. Downloaded by ..... tively low risk of contracting HIV regardless of the safety of medical practice ... McCabe, Brian E; Schaefer Solle, Natasha; Peragallo Montano, Nilda; Mitrani, Victoria B Alcohol misuse and depressive symptoms have been linked to HIV/STI risk, but studies have rarely included Hispanic women, who have over four times greater HIV incidence than white, non-Hispanic women. Understanding the connections among alcohol misuse, depressive symptoms, and HIV/STI risks may suggest ways to meet specific needs of Hispanic women. This study's objective is to examine the relationships among alcohol misuse, depressive symptoms, and seven HIV/STI risk factors. Five hundred forty-eight US Hispanic women with intake data from a randomized trial were assessed for alcohol misuse (CAGE) and depressive symptoms (CES-D). GZLM and path analyses tested relationships between alcohol misuse or depressive symptoms and HIV/STI risk factors. Self-efficacy and condom use were not related to alcohol misuse or depressive symptoms, but only 15% of women reported consistent condom use. After controlling for demographics, women with alcohol misuse had significantly more perceived HIV/STI risk (OR = 2.15) and better HIV/STI knowledge (β = -.54); and women with depressive symptoms had significantly more perceived HIV/STI risk (OR = 1.76) and worse HIV/STI knowledge (β = .37). Interventions to increase condom use for Hispanic women are needed, regardless of mental disorders. Working with Hispanic women with alcohol misuse or depressive symptoms presents a need (and opportunity) to address issues directly related to HIV/STI risk. Women's health practitioners have an excellent opportunity to reach women by implementing regular screening programs in clinics that serve Hispanic women. For women with high depressive symptoms, poor HIV/STI knowledge should also be addressed. Future studies should test whether integrated and tailored risk reduction interventions affect these factors and lower HIV/STI risk for Hispanic women. Dutta, Anupriya; Uno, Hajime; Holman, Alex; Lorenz, David R; Gabuzda, Dana African American men have the highest incidence of prostate cancer among ethnic groups, and racial disparity is highest in younger men. Prostate cancer prevalence is rising in HIV-infected men due to improved survival on antiretroviral therapies, yet little is known about racial differences in prostate cancer risk by HIV-infection status and age. This is a prospective cohort study of prostate cancer risk in 2,800 HIV-infected and -uninfected men who have sex with men (MSM) aged 40-70 years (22% African American) who were enrolled in the multicenter AIDS cohort study from 1996 to 2010. Poisson regression models were used to examine associations between race and HIV-infection status and prostate cancer risk among men aged 40-70, 40-55, and 56-70 years. Among men aged 40-70 years, incidence rates (IR) per 100,000 person-years were 169 among all men and 276 among African American HIV-infected men. Prostate cancer risk was similar by HIV-infection status (IRR 1.0, 95% CI 0.55-1.82), but nearly threefold higher in African Americans compared to non-African Americans in adjusted models (IRRs 2.66 and 3.22, 95% CIs 1.36-5.18 and 1.27-8.16 for all or HIV-infected men, respectively). Racial disparity in prostate cancer risk was greatest in African American men aged 40-55 years (adjusted IRR 3.31, 95% CI 1.19-9.22). Prostate cancer risk showed associations with family history of prostate cancer (p = 0.001), but not heavy smoking, androgen supplement use, or HIV-related factors. Among MSM, African American HIV-positive and HIV-negative men aged 40-55 years have threefold increased risk of young-onset prostate cancer compared to non-African American men, highlighting the need to make informed decisions about screening in this population. Poteat, Tonia; Wirtz, Andrea L; Radix, Anita; Borquez, Annick; Silva-Santisteban, Alfonso; Deutsch, Madeline B; Khan, Sharful Islam; Winter, Sam; Operario, Don Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population. PMID:25059941 Bennett, David S; Hersh, Jill; Herres, Joanna; Foster, Jill Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12-24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH. Simbayi, Leickness C; Kalichman, Seth C; Jooste, Sean; Cherry, Charsey; Mfecane, Sakhumzi; Cain, Demetria South Africa is in the midst of a devastating HIV-AIDS epidemic and most new HIV infections occur among young adults and adolescents. The current study examined risk behaviors and HIV risk factors among young people living in a Black South African township. Using community-based outreach methods of street intercept and facility-based surveying, 113 men and 115 women age 25 and younger responded to an anonymous survey. Results showed that men (68%) and women (56%) reported HIV-related high risk sexual behaviors. Although knowledge about HIV transmission was generally high, there was evidence that misconceptions about AIDS persist, particularly myths related to HIV transmission. For young men, HIV risk factors were associated with fewer years of education, lower levels of AIDS-related knowledge, condom attitudes, and Dagga (marijuana) use. Among young women, HIV risk factors were associated with beliefs that condoms get in the way of sex and rates of unprotected vaginal intercourse. Despite adequate general AIDS knowledge and risk sensitization, South African youth demonstrated high rates of sexual practices that place them at risk for HIV infection. There is an urgent need for behavioral interventions targeted to young South Africans living in the most economically disadvantaged areas. Full Text Available Background. The CDC recommends persons at high-risk for HIV infection in the United States receive annual HIV testing to foster early HIV diagnosis and timely linkage to health care. Heterosexuals make up a significant proportion of incident HIV infections (>25%, but test for HIV less frequently than those in other risk categories. Yet factors that promote or impede annual HIV testing among heterosexuals are poorly understood. The present study examines individual/attitudinal-, social-, and structural-level factors associated with past-year HIV testing among heterosexuals at high-risk for HIV. Methods. Participants were African American/Black and Hispanic heterosexual adults (N=2307 residing in an urban area with both high poverty and HIV prevalence rates. Participants were recruited by respondent-driven sampling (RDS in 2012-2015 and completed a computerized structured assessment battery covering background factors, multi-level putative facilitators of HIV testing, and HIV testing history. Separate logistic regression analysis for males and females identified factors associated with past-year HIV testing.Results. Participants were mostly male (58%, African American/Black (75%, and 39 years old on average (SD = 12.06 years. Lifetime homelessness (54% and incarceration (62% were common. Half reported past-year HIV testing (50% and 37% engaged in regular, annual HIV testing. Facilitators of HIV testing common to both genders included sexually transmitted infection (STI testing or STI diagnosis, peer norms supporting HIV testing, and HIV testing access. Among women, access to general medical care and extreme poverty further predicted HIV testing, while recent drug use reduced the odds of past-year HIV testing. Among men, past-year HIV testing was also associated with lifetime incarceration and substance use treatment.Conclusions. The present study identified gaps in rates of HIV testing among heterosexuals at high-risk for HIV, and both common and Full Text Available Abstract Background More than 340 million cases of curable sexually transmitted infections (STIs were estimated to have occurred worldwide in 1995. Previous studies have shown that the presence of other concomitant STIs increases the likelihood of HIV transmission. The first national study of STIs conducted in Pakistan in 2004 revealed a high burden of STIs among women selling sex. The HIV epidemic in Pakistan has thus far followed the "Asian epidemic model". Earlier studies among women selling sex have shown a low prevalence of HIV coupled with a low level of knowledge about AIDS. The aim of our study was to estimate the prevalence of HIV and STIs, and assess knowledge and risk behaviours related to HIV/STI, among women selling sex in Lahore, Pakistan. Methods A total of 730 participants were recruited through respondent-driven sampling. The participants were women selling sex in three areas (referred to as "A", "B", and "C" of Lahore. A structured questionnaire addressing demographic information, sexual life history, sexual contacts, and knowledge and practices related to HIV/STI prevention was administered by face-to-face interview. Biological samples were obtained from all participants and tested for HIV, Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. Pearson's chi-square and multivariable logistic regression analysis were performed to test associations between potential risk factors and specified diagnosed infections. Results The prevalence of HIV infection was 0.7%, T pallidum 4.5%, N gonorrhoeae 7.5%, C trachomatis 7.7% and T vaginalis 5.1%. The participants had been selling sex for a median period of seven years and had a median of three clients per day. Sixty five percent of the participants reported that they "Always use condom". The median fee per sexual contact was Rs. 250 (3 Euro. Compared to Areas A and C, women selling sex in Area B had a significantly higher risk of chlamydial Mkandawire-Valhmu, Lucy; Wendland, Claire; Stevens, Patricia E; Kako, Peninnah M; Dressel, Anne; Kibicho, Jennifer The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage. Full Text Available Background: HIV in India is transmitted primarily by heterosexual contact. The present study sought to test the feasibility of a group HIV/STI risk reduction intervention among heterosexual couples in India. Methods: Focus groups and key informant interviews were used in 2008 to culturally tailor the intervention. Thirty sexually active and HIV/STI negative couples were enrolled and assessed regarding risk behavior and sexual barrier acceptability. Gender-concordant group sessions used cognitive behavioral strategies for HIV/STI prevention. Results: At baseline, male condom use was low (36%; no participants reported use of female condoms or vaginal gels. HIV knowledge was low; women had more HIV knowledge and more positive attitudes towards condom use than men. Post-intervention, willingness to use all barrier products (t = 10.0, P< .001 and intentions to avoid risk behavior increased (t = 5.62, P< .001. Conclusion: This study illustrates the feasibility of utilizing a group intervention to enhance HIV/STI risk reduction among Indian couples. Dolan, Kate; Larney, Sarah HIV is a major health challenge for prison authorities. HIV in prisons has implications for HIV in the general community. The aim of this paper was to gather information on HIV risk, prevalence, prevention and treatment in prisons in India. Relevant published and unpublished reports and information were sought in order to provide a coherent picture of the current situation relating to HIV prevention, treatment and care in prisons in India. Information covered prison management and population statistics, general conditions in prisons, provision of general medical care and the HIV situation in prison. No data on drug injection in prison were identified. Sex between men was reported to be common in some Indian prisons. A national study found that 1.7 per cent of inmates were HIV positive. Some prisons provided HIV education. Condom provision was considered illegal. A few prisoners received drug treatment for drug use, HIV infection or co-infection with sexually transmitted infections (STIs). HIV prevalence in prisons in India was higher than that in the general community. Regular monitoring of information on HIV risk behaviours and prevalence in Indian prisons is strongly recommended. Evidence based treatment for drug injectors and nation-wide provision of HIV prevention strategies are urgently required. Voluntary counselling, testing and treatment for HIV and STIs should be provided. Robertson, Angela A.; St. Lawrence, Janet S.; McCluskey, D. Lee Drug abusing offenders have high rates of HIV and other sexually transmitted infections (STI). To date, the HIV/STI prevention needs of offenders in drug court programs have been ignored. This multi-method study employed interviews to assess drug court professionals' perceptions of the need for an HIV risk reduction intervention to be integrated… Substance abuse and HIV risk behaviours amongst primary health care service users in Cape Town. ... African Journal of Psychiatry ... We assessed substance use with the Alcohol, Smoking and Substance Involvement Screening Test, and HIV risk with items addressing injection drug use, blood-sharing rituals, and sexual ... TB has a negative impact on HIV, increasing the risk of HIV-related morbidity ... Objectives. To describe the sociodemographic and outcome characteristics of TB patients, and to identify risk factors associated with TB ..... Cunningham J, Perkins M. Diagnostics for tuberculosis: Global demand and market potential. 2006. To determine the association between mental health, substance use and HIV sexual risk behaviour among a sample of university ... analysis, HIV risk behaviour was associated with, among men, hazardous or harmful alcohol use and having screened positive for PTSD, and ..... risk behaviors among U.S. adolescents. Full Text Available The aim of this study was to identify factors affecting HIV risk reduction among 150 Black and 150 White South Africans chosen by systematic random sampling. Main outcome measures included sexual behaviour and condom use, knowledge about correct condom use, intention of condom use, behavioural norms, attitudes, normative beliefs, and subjective norms about condoms, HIV/AIDS health beliefs, and HIV risk behaviour. Bivariate analysis gave positive significant relations among being single, age, HIV/ AIDS perceived severity, HIV/AIDS prevention barriers and HIV risk behaviour. Further, bivariate analysis gave negative significant relations among age at onset of puberty, age at first vaginal intercourse, correct condom use knowledge, subjective norms, intention to use condoms and HIV risk behaviour. Regression analysis indicated that for subjective norm to use condoms, less intention for condom use, less condom use knowledge and younger age of first vaginal intercourse were predictive for HIV/AIDS risk behaviour. HIV prevention intervention programmes should include the identified factors and cultural diversity. Rizwan Suliankatchi Abdulkader Full Text Available Background: Male migrants act as a bridge for transmitting infection from core risk groups to general population and hence this group becomes essential for the HIV control program. Migrant workers constitute a large proportion of workforce in India and HIV/AIDS epidemic in them would cause huge economic losses. Objectives: The aim of this study was to ascertain the HIV-risk behavior among male migrant factory workers. Materials and Methods: This was a cross-sectional facility based survey conducted in 2011. Male migrant workers aged ≥18 years, who were born outside Haryana, who had moved to current location after 15 years of age, who had worked in the current factory for at least one year, who were willing to participate and able to give valid consent were eligible. A consecutive sampling was done. Descriptive, bivariate and multiple logistic regression analyses were done. Results: A total of 755 male subjects completed the interview. About 21.5% had experienced non-spousal sexual intercourse in last one year. Nearly 60% did not use a condom at the last non-spousal sex. Factors associated with recent non-spousal sex were being unmarried, younger age at migration, recent migration to Haryana, greater number of places migrated and lesser total duration of migration and those associated with non-use of condom at the last non-spousal sex were older age, lower education, lesser number of places migrated and lower level of HIV/AIDS knowledge. Conclusion: Unprotected, recent non-spousal sex was common among male migrants, which could increase their HIV/AIDS vulnerability. Klein, Hugh; Elifson, Kirk W; Sterk, Claire E In this study, we examined the relationship between depression and HIV-related risk behavior practices in a sample of 250 at risk, predominantly African American women living in the Atlanta, Georgia metropolitan area. Interviews were conducted between August 1997 and August 2000. Street outreach efforts were used to identify potential study participants, with further expansion of the sample via targeted sampling and ethnographic mapping procedures. Our conceptual model hypothesized a relationship between depression and HIV risk in which depression and condom-related attitudes were construed as intervening (or mediating) variables. A multivariate analysis was used to determine the relationship between depression and women's risk behaviors. The results showed that depression was a key-mediating variable, having its primary influence on women's risky practices through its impact upon their attitudes toward using condoms. Factors associated with depression, included religiosity, closeness of family relationships, financial problems, childhood maltreatment experiences, and drug-related problems. The implications of these findings for prevention and intervention efforts are: (1) heightening faith community involvement and religious participation to decrease depression; (2) working with women whose familial bonds are in need of strengthening to combat depression; (3) providing mental health and counseling services to women who were emotionally and/or sexually abused during their formative years seems to help these women to recover from unresolved issues that may be fueling depression; (4) assisting at risk women who need training in money management issues to minimize their risk for depression; and (5) helping women drug abusers to receive treatment for their drug problems to combat their depression and lower their HIV risk. Sally N. Adebamowo Full Text Available BackgroundThe prevalence, persistence, and multiplicity of human papillomavirus (HPV infection appears different comparing HIV-positive to HIV-negative women. In this study, we examined prevalent, persistent, and multiple low- and high-risk cervical HPV infections in HIV-negative and HIV-positive women.MethodsWe studied 1,020 women involved in a study of HPV infection using SPF25/LiPA10. Two study visits were scheduled, at enrollment and 6 months afterward. At each study visit, research nurses used a cervical brush to collect samples of exfoliated cervical cells from the cervical os, from all the study participants. Exact logistic regression models were used to estimate associations between HIV and HPV infections.ResultsThe mean (SD age of the study participants was 38 (8 years, 56% were HIV-negative and 44% were HIV-positive. Among HIV-negative women at baseline, single low-risk HPV (lrHPV infections occurred in 12%; multiple lrHPV in 2%; single high-risk human papillomavirus (hrHPV infections in 9%, and multiple hrHPV infections in 2%. Single lrHPV infections were persistent in 6%, but there was no persistent multiple lrHPV infections. Single hrHPV infections were persistent in 4% while multiple hrHPV infections were persistent in 0.3%. Among HIV-positive women at baseline, single lrHPV infections occurred in 19%, multiple lrHPV in 6%, single hrHPV infections in 17%, and multiple hrHPV infections occurred in 12%. Single lrHPV infections were persistent in 9%, multiple lrHPV infections in 0.6%, single hrHPV infections in 13%, while multiple hrHPV were persistent in 3%. Prevalent, persistent, and multiple infections were more common in HIV-positive women, compared to HIV-negative women. In multivariate models adjusted for age, marital status, socioeconomic status, age at sexual initiation, and douching, the odds ratios comparing HIV-positive to HIV-negative women, were 2.09 (95% CI 1.47–2.97, p < 0.001 for prevalent lrHPV, 1.26 (95% CI Frye, Victoria; Nandi, Vijay; Egan, James; Cerda, Magdalena; Greene, Emily; Van Tieu, Hong; Ompad, Danielle C; Hoover, Donald R; Lucy, Debbie; Baez, Eduardo; Koblin, Beryl A Understanding what social factors are associated with risk of HIV acquisition and transmission among gay, bisexual and other men who have sex with men (MSM) is a critical public health goal. Experiencing discrimination may increase risk of HIV infection among MSM. This analysis assessed relations between experiences of sexual orientation- and race-based discrimination and sexual HIV risk behavior among MSM in New York City. 1,369 MSM completed a self-administered computerized assessment of past 3-month sexual behavior, experience of social discrimination and other covariates. Regression models assessed relations between recent experience of discrimination and sexual HIV risk behavior. Mean age was 32 years; 32 % were white; 32 % Latino/Hispanic; 25 % African American/Black. Of MSM who self-reported HIV-positive or unknown status (377), 7 % (N = 27) reported having unprotected insertive anal intercourse with an HIV-negative or unknown status partner ("HIV transmission risk"). Of MSM who self-reported HIV-negative status (992), 11 % (110) reported unprotected receptive anal intercourse with an HIV-positive or unknown status partner ("HIV acquisition risk"). HIV acquisition risk was positively associated with sexual orientation-based discrimination in home or social neighborhoods, but not race-based discrimination. We observed that sexual orientation-based discrimination was associated with sexual HIV risk behavior among urban-dwelling MSM. Addressing environmental sources of this form of discrimination, as well as the psychological distress that may result, should be prioritized in HIV prevention efforts. Guo, W; Li, Y; Zhou, N; Wu, G H; Chang, W H; Huan, X P; Hui, S; Tong, X; Guo, Y; Yu, M H; Lu, R R; Ouyang, L; Dong, L F; Li, H; Li, J J; Liu, X Y; Liu, Y L; Luo, C; Wei, X L; Huang, X D; Cui, Y Objectives: To analyze and understand the risk factors related to HIV new infections among men who have sex with men (MSM). Methods: A longitudinal observational study among MSM was conducted to collect information on HIV related behaviors and sero-conversion. Univariate and multivariate generalized estimating equations (GEE) were used to discuss the risk factors for HIV new infection. Results: A total number of 4 305 MSM were followed during 2013-2015. Among those self-reported MSM who are seeking partners on the Interner tended to have higher proportion on receptive anal intercourse and consistent condom use during anal intercourse than the subgroups seeking their partners in gay bars or bathrooms. HIV incidence among followed MSM during the study period appeared as 4.3/100 person years, with adjusted RR (a RR ) of HIV infection for receptive anal intercourse as group 2.20 (95% CI : 1.49-3.24) times than that of insertion anal intercourse group. Those who used rush-poppers (a RR =1.55, 95% CI : 1.10-2.17), unprotected anal intercourse (a RR =2.24, 95% CI : 1.62-3.08), and those with syphilis infection (a RR =2.95, 95% CI : 2.00-4.35) were also risk factors for HIV new infections. After controlling other factors, the relationship between the ways of seeking partners and HIV new infection was not statistical significant. Conclusion: Risk factors for HIV new infection among MSM appeared complex and interactive, suggesting that further studies are needed to generate tailored strategies for the prevention of HIV epidemic among MSM population. Sarker, Malabika; Milkowski, Andrea; Slanger, Tracy; Gondos, Adam; Sanou, Aboubakary; Kouyate, Bocar; Snow, Rachel We conducted a random community based survey of 300 young (15-29 years) rural women in Nouna, Burkina Faso. Only one-third of women were aware that a person could have HIV without having symptoms and these women were significantly more likely to classify themselves to be at high risk for getting HIV. Furthermore, multiple partners, Bwaba ethnicity and having mentioned a health worker as a source of HIV information were significantly associated with perceived high personal risk. Perceived willingness to participate in VCT was high (69%). The dissemination of information on the asymptomatic nature of HIV infection could potentially be very important in forming risk perception, awareness, and their willingness to participate in HIV interventions. Dolan, Kate; Larney, Sarah Background & Objectives: HIV is a major health challenge for prison authorities. HIV in prisons has implications for HIV in the general community. The aim of this paper was to gather information on HIV risk, prevalence, prevention and treatment in prisons in India. Methods: Relevant published and unpublished reports and information were sought in order to provide a coherent picture of the current situation relating to HIV prevention, treatment and care in prisons in India. Information covered... Full Text Available Danai Tavonga Zhou,1,2 Vitaris Kodogo,1 Kudzai Fortunate Vongai Chokuona,1 Exnevia Gomo,1 Olav Oektedalen,3 Babill Stray-Pedersen21Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Avondale, Zimbabwe; 2Institute of Clinical Medicine, University in Oslo, Oslo University Hospital, Oslo, Norway; 3Department of Infectious Diseases, Oslo University Hospital, Oslo, NorwayAbstract: The chronic inflammation induced by human immunodeficiency virus (HIV contributes to increased risk of coronary heart disease (CHD in HIV-infected individuals. HIV-infected patients generally benefit from being treated with antiretroviral drugs, but some antiretroviral agents have side effects, such as dyslipidemia and hyperglycemia. There is general consensus that antiretroviral drugs induce a long-term risk of CHD, although the levels of that risk are somewhat controversial. The intention of this cross-sectional study was to describe the lipid profile and the long-term risk of CHD among HIV-positive outpatients at an HIV treatment clinic in Harare, Zimbabwe. Two hundred and fifteen patients were investigated (females n=165, mean age 39.8 years; males n=50; mean age 42.0 years. Thirty of the individuals were antiretroviral-naïve and 185 had been on antiretroviral therapy (ART for a mean 3.9±3.4 years. All participants had average lipid and glucose values within normal ranges, but there was a small difference between the ART and ART- for total cholesterol (TC and high-density lipoprotein (HDL.Those on a combination of D4T or ZDV/NVP/3TC and PI-based ART were on average oldest and had the highest TC levels. Framingham risk showed 1.4% prevalence of high CHD risk within the next ten years. After univariate analysis age, sex, TC/HDL ratio, HDL, economic earnings and systolic BP were associated with medium to high risk of CHD. After multivariate regression analysis and adjusting for age or sex only age, sex and economic earnings Paul K Drain Full Text Available After observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults.We surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count <100 cells/mm(3. We used multivariate regression models to determine the effects of sex, emotional health, social support, distance from clinic, employment, perceived barriers to receiving healthcare, and foregoing healthcare to use money for food, clothing, or housing ("competing needs to healthcare" on presentation with late-stage HIV disease.Among 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6% presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR 2.8, 95% CI 1.7-4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2-2.4, were male (AOR 1.7, 95% CI 1.2-2.3, worked outside the home (AOR 1.5, 95% CI 1.1-2.1, perceived health service delivery barriers (AOR 1.5, 95% CI 1.1-2.1, and/or had poor emotional health (AOR 1.4, 95% CI 1.0-1.9 had higher odds of late-stage HIV disease presentation.Independent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease. Noroozi, Mehdi; Ahounbar, Elahe; Karimi, Salah Eddin; Ahmadi, Sina; Najafi, Mohammad; Bazrafshan, Ali; Shushtari, Zahra Jorjoran; Farhadi, Mohammad Hassan; Higgs, Peter; Rezaei, Fatemeh; Ghiasvand, Hesam; Sharhani, Asaad; Armoon, Bahram; Waye, Katherine Understanding and increasing awareness on individual risk for HIV infection as well as HIV risk perception's effects on different behavioral outcomes for people who inject drugs (PWID) is important for policymaking and planning purposes. The objectives of the present study were to determine whether HIV risk perception was associated with greater injection and sexual risk-taking behaviors among PWIDs. We surveyed 460 PWID in Kermanshah regarding their demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Three classes of HIV risk perception were identified using ordinal regression to determine factors associated with HIV risk perception. Study participants were categorized as follows: "low" (n = 100, 22%), "moderate" (n = 150, 32%), and "high" (n = 210, 46%) risk perception for becoming infected with HIV. The odds of categorizing as "high" risk for HIV was significantly greater in PWID that reported unprotected sex (adjusted odds ratio (AOR) 2.4, p value 0.02), receptive syringe sharing (AOR 1.8, p value 0.01), and multiple sex partners (AOR 1.4, p value 0.03). PWID who reported unprotected sex had 2.7 times the odds of "high" risk perception when compared to PWID with "low" risk perception. Findings show that PWID could rate their HIV risk with acceptable accuracy. Additionally, perceived HIV risk was associated with many risk factors for transmission of HIV, emphasizing the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug-related use. Koenig, Linda J.; Whitaker, Daniel J.; Royce, Rachel A.; Wilson, Tracey E.; Callahan, Michelle R.; Fernandez, M. Isabel Objectives. This study estimated the prevalence of violence during pregnancy in relation to HIV infection. Methods. Violence, current partnerships, and HIV risk behaviors were assessed among 336 HIV-seropositive and 298 HIV-seronegative at-risk pregnant women. Results. Overall, 8.9% of women experienced recent violence; 21.5% currently had abusive partners. Violence was experienced by women in all partnership categories (range = 3.8% with nonabusive partners to 53.6% with physically abusive partners). Neither experiencing violence nor having an abusive partner differed by serostatus. Receiving an HIV diagnosis prenatally did not increase risk. Disclosure-related violence occurred, but was rare. Conclusions. Many HIV-infected pregnant women experience violence, but it is not typically attributable to their serostatus. Prenatal services should incorporate screening and counseling for all women at risk for violence. (Am J Public Health. 2002;92:367–370) PMID:11867312 Full Text Available Recent studies suggest that acquisition of HIV-1 infection during pregnancy and breastfeeding is associated with a high risk of HIV mother-to-child transmission. This study evaluates risk factors associated with HIV acquisition during pregnancy in women delivering at a large metropolitan medical facility located in the south of Brazil. From February to August 2009, our group conducted a cross-sectional study assessing women’s risk for HIV acquisition by administering an oral survey to peripartum women. Of 2465 participants, 42% (n=1046 knew that partner had been tested for HIV. During pregnancy, 82% (n=2022 of participants never used condoms; yet 97% (n=2399 practiced vaginal sex. Multivariate logistic regression analysis showed that patients with more years of education, in a relationship for more than 1 year, and who knew their own HIV status were more likely to know their partners' HIV status (P<0.05. Those who were in relationship for more than 1 year and were married/living together were more likely to be comfortable discussing HIV testing with partners (P<0.05. In conclusion, women in Brazil are at risk of HIV-infection during pregnancy as they remain sexually active, often do not know their sexual partner’s HIV status, and have minimal condom use. Full Text Available Abstract Background HIV risk perceptions are a key determinant of HIV testing. The success of efforts to achieve an AIDS-free generation – including reaching the UNAIDS 90–90-90 target – thus depends critically on the content of these perceptions. We examined the accuracy of HIV-risk perceptions and their correlates among young black women in South Africa, a group with one of the highest HIV incidence rates worldwide. Methods We used individual-level longitudinal data from the Cape Area Panel Study (CAPS from 2005 to 2009 on black African women (20–30 years old in 2009 to assess the association between perceived HIV-risk in 2005 and the probability of testing HIV-positive four years later. We then estimated multivariable logistic regressions using cross-sectional data from the 2009 CAPS wave to assess the relationship between risk perceptions and a wide range of demographic, sexual behaviour and psychosocial covariates of perceived HIV-risk. Results We found that the proportion testing HIV-positive in 2009 was almost identical across perceived risk categories in 2005 (no, small, moderate, great (χ 2 = 1.43, p = 0.85. Consistent with epidemiologic risk factors, the likelihood of reporting moderate or great HIV-risk perceptions was associated with condom-use (aOR: 0.57; 95% CI: 0.36, 0.89; p < 0.01; having ≥3 lifetime partners (aOR: 2.38, 95% CI: 1.53, 3.73; p < 0.01; knowledge of one’s partner’s HIV status (aOR: 0.67; 95% CI: 0.43, 1.07; p = 0.09; and being in an age-disparate partnerships (aOR: 1.73; 95% CI: 1.09, 2.76; p = 0.02. However, the likelihood of reporting moderate or great self-perceived risk did not vary with sexually transmitted disease history and respondent age, both strong predictors of HIV risk in the study setting. Risk perceptions were associated with stigmatising attitudes (aOR: 0.53; 95% CI: 0.26, 1.09; p = 0.09; prior HIV testing (aOR: 0.21; 95% CI: 0.13, 0.35; p < 0.01; and having heard Deuba, Keshab; Ekström, Anna Mia; Tomson, Göran; Shrestha, Rachana; Marrone, Gaetano We assessed changes in HIV prevalence and risk behaviours among young key populations in Nepal. A total of 7505 participants (aged 16-24 years) from key populations who were at increased risk of HIV infection (2767 people who inject drugs (PWID); 852 men who have sex with men/transgender (MSM/TG); 2851 female sex workers (FSW) and 1035 male labour migrants) were recruited randomly over a 12-year period, 2001-2012. Local epidemic zones of Nepal (Kathmandu valley, Pokhara valley, Terai Highway and West to Far West hills) were analysed separately. We found a very strong and consistent decline in HIV prevalence over the past decade in different epidemic zones among PWID and MSM/TG in Kathmandu, the capital city, most likely due to a parallel increase in safe needle and syringe use and increased condom use. A decrease in HIV prevalence in 22 Terai highway districts, sharing an open border with India, was also consistent with increased condom use among FSW. Among male labour migrants, HIV prevalence was low throughout the period in the West to Far West hilly regions. Condom use by migrant workers involved with FSW abroad increased while their condom use with Nepalese FSW declined. Other risk determinants such as mean age at starting first injection, injection frequency, place of commercial sex solicitation, their mean age when leaving to work abroad did not change consistently across epidemic zones among the young key populations under study. In Nepal, the decline in HIV prevalence over the past decade was remarkably significant and consistent with an increase in condom use and safer use of clean needles and syringes. However, diverging trends in risk behaviours across local epidemic zones of Nepal suggest a varying degree of implementation of national HIV prevention policies. This calls for continued preventive efforts as well as surveillance to sustain the observed downward trend. Okafor, Uchenna Onyekachi; Crutzen, Rik; Ifeanyi, Okekearu; Adebajo, Sylvia; Van den Borne, Hubertus Female sex workers (FSWs) have been identified as a core group in the transmission of HIV and other sexually transmitted infections (STIs). Young FSWs are particularly more vulnerable to HIV due to the combination of vulnerabilities associated with their youth and the sex work they engage in. This study aims to give more insight into HIV prevalence and sexual risk behaviour of young FSWs in Nigeria, by focusing on the differences between BB and NBB young FSWs. Data was obtained from the Nigeria Integrated Biological and Behavioural Surveillance Survey (IBBSS) for high-risk groups conducted in 2010. IBBSS is a quantitative survey conducted amongst identified high-risk sub populations within Nigeria. HIV prevalence and risk behaviour data for young BB and NBB FSWs aged 15-24 years for nine states was extracted and analysed. A total of 1796 FSWs aged 15-24 years were interviewed during the survey, 746 (41.5%) were BB while 1050 (58.5%) were NBB. The HIV prevalence was higher among BB FSWs compared to the NBB FSWs (21.0% vs. 15.5%). BB FSWs reported less condom use with boyfriends and casual partners than NBB FSWs (26.3% vs. 45.5%) and (55.1% vs. 61.1%) respectively while risk of HIV infection due to injecting drug use was higher in NBB compared to BB FSWs (6.6% vs. 1.2%). Existing and future interventions on HIV prevention should focus on empowering young FSWs with innovative and sustainable approaches aimed at improving their health and wellbeing. Taylor, Tory M; Hembling, John; Bertrand, Jane T To describe levels of risky sexual behaviour, HIV testing and HIV knowledge among men and women in Guatemala by ethnic group and to identify adjusted associations between ethnicity and these outcomes. Data on 16,205 women aged 15-49 and 6822 men aged 15-59 from the 2008-2009 Encuesta Nacional de Salud Materno Infantil were used to describe ethnic group differences in sexual behaviour, HIV knowledge and testing. We then controlled for age, education, wealth and other socio-demographic factors in a multivariate logistic regression model to examine the effects of ethnicity on outcomes related to age at sexual debut, number of lifetime sex partners, comprehensive HIV knowledge, HIV testing and lifetime sex worker patronage (men only). The data show low levels of risky sexual behaviour and low levels of HIV knowledge among indigenous women and men, compared to other respondents. Controlling for demographic factors, indigenous women were more likely than other women never to have been tested for HIV and to lack comprehensive HIV knowledge. They were less likely to report early sexual debut and three or more lifetime sexual partners. Indigenous men were more likely than other men to lack comprehensive HIV knowledge and demonstrated lower odds of early sexual debut, 10 or more lifetime sexual partners and sex worker patronage. The Mayan indigenous population in Guatemala, while broadly socially vulnerable, does not appear to be at elevated risk for HIV based on this analysis of selected risk factors. Nonetheless, low rates of HIV knowledge and testing may be cause for concern. Programmes working in indigenous communities should focus on HIV education and reducing barriers to testing. Further research into the factors that underlie ethnic self-identity and perceived ethnicity could help clarify the relative significance of these measures for HIV risk and other health outcomes. The questionnaire was designed to assess variables that influence athletes attitudes towards the risk of HIV transmission of through sport. The research questionnaire was influenced by a similar study conducted by Calabrese10 in 1993, which was confined only to college students and did not differentiate between risk ... Full Text Available INTRODUCTION: Targeting most-at-risk individuals with HIV preventive interventions is cost-effective. We developed gender-specific indices to measure risk of HIV among sexually active individuals in Rakai, Uganda. METHODS: We used multivariable Cox proportional hazards models to estimate time-to-HIV infection associated with candidate predictors. Reduced models were determined using backward selection procedures with Akaike's information criterion (AIC as the stopping rule. Model discrimination was determined using Harrell's concordance index (c index. Model calibration was determined graphically. Nomograms were used to present the final prediction models. RESULTS: We used samples of 7,497 women and 5,783 men. 342 new infections occurred among females (incidence 1.11/100 person years, and 225 among the males (incidence 1.00/100 person years. The final model for men included age, education, circumcision status, number of sexual partners, genital ulcer disease symptoms, alcohol use before sex, partner in high risk employment, community type, being unaware of a partner's HIV status and community HIV prevalence. The Model's optimism-corrected c index was 69.1 percent (95% CI = 0.66, 0.73. The final women's model included age, marital status, education, number of sex partners, new sex partner, alcohol consumption by self or partner before sex, concurrent sexual partners, being employed in a high-risk occupation, having genital ulcer disease symptoms, community HIV prevalence, and perceiving oneself or partner to be exposed to HIV. The models optimism-corrected c index was 0.67 (95% CI = 0.64, 0.70. Both models were well calibrated. CONCLUSION: These indices were discriminative and well calibrated. This provides proof-of-concept that population-based HIV risk indices can be developed. Further research to validate these indices for other populations is needed. Shaboltas Alla V Full Text Available Abstract Background The HIV epidemic in Russia has been driven by the unsafe injection of drugs, predominantly heroin and the ephedrine derived psychostimulants. Understanding differences in HIV risk behaviors among injectors associated with different substances has important implications for prevention programs. Methods We examined behaviors associated with HIV risk among 900 IDUs who inject heroin, psychostimulants, or multiple substances in 2002. Study participants completed screening questionnaires that provided data on sociodemographics, drug use, place of residence and injection- and sex-related HIV risk behaviors. HIV testing was performed and prevalence was modeled using general estimating equation (GEE analysis. Individuals were clustered by neighborhood and disaggregated into three drug use categories: Heroin Only Users, Stimulant Only Users, and Mixed Drug Users. Results Among Heroin Only Users, younger age, front/backloading of syringes, sharing cotton and cookers were all significant predictors of HIV infection. In contrast, sharing needles and rinse water were significant among the Stimulant Only Users. The Mixed Drug Use group was similar to the Heroin Only Users with age, front/back loading, and sharing cotton significantly associated with HIV infection. These differences became apparent only when neighborhood of residence was included in models run using GEE. Conclusion The type of drug injected was associated with distinct behavioral risks. Risks specific to Stimulant Only Users appeared related to direct syringe sharing. The risks specific to the other two groups are common to the process of sharing drugs in preparation to injecting. Across the board, IDUs could profit from prevention education that emphasizes both access to clean syringes and preparing and apportioning drug with these clean syringes. However, attention to neighborhood differences might improve the intervention impact for injectors who favor different drugs. Maleke, Kabelo; Makhakhe, Nosipho; Peters, Remco Ph; Jobson, Geoffrey; De Swardt, Glenn; Daniels, Joseph; Lane, Timothy; McIntyre, James A; Imrie, John; Struthers, Helen Rural South African men who have sex with men (MSM) are likely to be underserved in terms of access to relevant healthcare and HIV prevention services. While research in urban and peri-urban MSM populations has identified a range of factors affecting HIV risk in South African MSM, very little research is available that examines HIV risk and prevention in rural MSM populations. This exploratory study begins to address this lack by assessing perceptions of HIV risk among MSM in rural Limpopo province. Using thematic analysis of interview and discussion data, two overarching global themes that encapsulated participants' understandings of HIV risk and the HIV risk environment in their communities were developed. In the first theme, "community experience and the rural social environment", factors affecting HIV risk within the broad risk environment were discussed. These included perceptions of traditional value systems and communities as homophobic; jealousy and competition between MSM; and the role of social media as a means of meeting other MSM. The second global theme, "HIV/AIDS knowledge, risk and experience", focused on factors more immediately affecting HIV transmission risk. These included: high levels of knowledge of heterosexual HIV risk, but limited knowledge of MSM-specific risk; inconsistent condom and lubricant use; difficulties in negotiating condom and lubricant use due to uneven power dynamics in relationships; competition for sexual partners; multiple concurrent sexual partnerships; and transactional sex. These exploratory results suggest that rural South African MSM, like their urban and peri-urban counterparts, are at high risk of contracting HIV, and that there is a need for more in-depth research into the interactions between the rural context and the specific HIV risk knowledge and behaviours that affect HIV risk in this population. Bobashev, Georgiy V.; Morris, Robert J.; Zule, William A. Longitudinal studies of health outcomes for HIV could be very costly cumbersome and not representative of the risk population. Conversely, cross-sectional approaches could be representative but rely on the retrospective information to estimate prevalence and incidence. We present an Agent-based Modeling (ABM) approach where we use behavioral data from a cross-sectional representative study and project the behavior into the future so that the risks of acquiring HIV could be studied in a dynamical/temporal sense. We show how the blend of behavior and contact network factors (sexual, injecting) play the role in the risk of future HIV acquisition and time till obtaining HIV. We show which subjects are the most likely persons to get HIV in the next year, and whom they are likely to infect. We examine how different behaviors are related to the increase or decrease of HIV risks and how to estimate the quantifiable risk measures such as survival HIV free. Aim The overall aim of this thesis was to investigate the association between mental disorder and risk of sexual HIV transmission in a low-income country with a generalized HIV epidemic. Specific objectives were to investigate in Uganda, (1) the association between common mental disorder and sexual risk behaviour, (2) how severe mental disorder could influence sexual risk behaviour, (3) the prevalence of HIV in persons with severe mental disorder, and (4) the association of severe mental d... Bauer-Staeb, Clarissa; Jörgensen, Lena; Lewis, Glyn; Dalman, Christina; Osborn, David P J; Hayes, Joseph F Severe mental illness is associated with increased morbidity and mortality. The elevated risk of blood-borne viruses (BBVs) in people with severe mental illness is of concern, but the full extent of this problem is unclear. We aimed to determine the prevalence of and risk factors for BBVs in people with severe mental illness. In this nationwide, population-based, cross-sectional study, we estimated the point prevalence of HIV, hepatitis B (HBV), and hepatitis C (HCV) in people with severe mental illness, including the total adult (≥18 years) Swedish population. We defined severe mental illness as a clinical diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, or other psychotic illness according to the Swedish version of the International Statistical Classification of Diseases version 8, 9, or 10. We used multivariable logistic regression to determine the odds of BBVs in individuals with severe mental illness, relative to the general population, and to identify independent risk factors (age, sex, immigration status, socioeconomic status, education, and substance misuse) for BBV infection. We also did a sensitivity analysis excluding BBV diagnoses made before the introduction of the Register for Infection Disease Control (1997). Of 6 815 931 adults in Sweden, 97 797 (1·43%) individuals had a diagnosis of severe mental illness. Prevalence of BBVs was elevated in people with severe mental illness, of which 230 (0·24%) had HIV, 518 (0·53%) had HBV, and 4476 (4·58%) had HCV. After accounting for sociodemographic characteristics, the odds of HIV were 2·57 (95% CI 2·25-2·94, pmental illness than in the general population, whereas the odds of HBV were 2·29 (2·09-2·51, pmental illness and identify interventions preventing infection. Targeting of comorbid substance misuse would have particular effect on reduction of BBV prevalence in this population. Medical Research Council and Swedish Research Council. Copyright © 2017 The Author Liu, Zhiying; Li, Wei; Xu, Meng; Sheng, Bo; Yang, Zixuan; Jiao, Yanmei; Zhang, Tong; Mou, Danlei; Chen, Dexi; Wu, Hao The detection of acute HIV infection (AHI) among high risk populations can help reduce secondary transmission of HIV. The nucleic acid testing (NAT) can shorten the test window period by up to 7-12 days. In this study, we describe an in-house NAT based on the multiplex nested RT-PCR method to detect the HIV RNA. We also evaluated it in a high risk cohort in Beijing. Four primer pairs were designed and evaluated for the detection of different HIV-1 subtypes in group M. Multiplex RT-PCR and nested PCR were performed. The sensitivity, specialty, primers compatibility among HIV subtypes were evaluated simultaneously. In an MSM cohort in Beijing during a 3-year period, a total of 11,808 blood samples that were negative by ELISA or indeterminate by Western blot were analyzed by this multiplex nested RT-PCR with pooling strategy. The multiplex nested RT-PCR was successfully applied for the detection of at least six HIV-1 subtypes. The sensitivity was 40 copies/ml and the specificity was 100%. A total of 29 people were tested HIV-1 positive with acute infection in a MSM cohort of Beijing during a 3 years period. This multiplex nested RT-PCR provides a useful tool for the rapid detection of acute HIV-1 infection. When used in combination with the 3(rd) generation ELISA, it can improve the detection rate of HIV infection, especially in the source limited regions. Smith, Tanyka K; Larson, Elaine L Human immunodeficiency virus (HIV) is a major public health concern in the United States, particularly among older Black women who comprise approximately 40% of the newly diagnosed cases among women. This systematic review sought to answer the research question: What are the sexual practices in older Black women associated with HIV risk? CINAHL, PubMed, MEDLINE, and Web of Knowledge electronic databases were searched for English-language research studies published between 2003 and 2013 that focused on the HIV sexual risk practices of Black women over the age of 50. Using PRISMA guidelines, two reviewers independently reviewed and appraised the quality of relevant articles; agreement of select studies was achieved by consensus. Among the 3,167 articles surveyed, 9 met inclusion criteria. The majority (88%) were quantitative, observational studies. All nine articles addressed at least one of three factors that contribute to HIV sexual risk: Behavioral (inconsistent condom use and multiple sexual partners), psychological (risk perception, depression/stress, trauma, and self-esteem issues), and social factors (economics, education, and drugs/alcohol use). Outcome measures varied across studies. Although this systematic review appraised few studies, findings suggest that many older Black women are engaged in HIV risk-taking practices. Clinicians and researchers need to be aware of the HIV risk practices of older Black women to improve health outcomes through education, effective communication and risk appraisal. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved. Full Text Available Even though a decline in HIV prevalence has been reported among South African youth 15–24 from 10.3% in 2005 to 8.6% in 2008, the prevalence remains disproportionately high for females overall in comparison to males. This study examines factors associated by HIV risk reduction self-efficacy of South African youth as part of an evaluation of the impact of loveLife, a youth focused HIV prevention programme. A cross-sectional population-based household survey was conducted with persons of ages 18 to 24 years in four selected provinces in South Africa. Among female respondents (, factors associated with high self-efficacy in the adjusted model were having a low HIV risk perception, HIV/AIDS stigma, ever using drugs, and having life goals. Male respondents ( with high self-efficacy were more likely to have been tested for HIV, have concurrent sexual partners, have had a transactional sex partner in lifetime, a low HIV risk perception, difficulty in having condoms, agreed with coercive sex, high relationship control, and had loveLife face-to-face programme participation. The factors identified with high self-efficacy and HIV-sexual risk behaviour may be considered to strengthen youth HIV prevention programmes in South Africa. Peterson, Zoё D; Janssen, Erick; Goodrich, David; Fortenberry, J Dennis; Hensel, Devon J; Heiman, Julia R Previous research has suggested that sexually aggressive behavior and sexual HIV risk behavior are associated. Childhood sexual abuse (CSA) is a well-established risk factor for both types of problematic sexual behavior. Negative affect (i.e., anxiety, depression, and anger) is a less well-studied risk factor, but it has been theorized to relate to both sexual aggression and HIV risk behavior. Thus, this study sought to (1) confirm the relationship between sexual aggression and HIV risk behavior, (2) establish CSA and negative affect as shared risk factors for sexual aggression and HIV risk behavior, and (3) evaluate whether negative affect mediates the relationship between CSA and sexual aggression and between CSA and HIV sexual risk in a sample of heterosexual men. We recruited 18- to 30-year-old heterosexual men (N = 377) from urban sexually transmitted infection clinics. Men completed measures of sexual HIV risk history (number of partners and condom use), sexual aggression history, CSA history, and trait negative affect (anger, anxiety, and depression). Structural equation modeling was used to examine hypothesized direct and indirect relationships. In the final SEM model, sexual aggression history and sexual HIV risk behavior were correlated. CSA was associated with both types of problematic sexual behavior. Anxiety significantly mediated the relationship between CSA and sexual aggression and between CSA and sexual HIV risk behavior (χ 2 = 2121.79, p Sexual aggression appears to be part of a constellation of sexual risk behaviors; thus, it may be possible to develop prevention programs that target both sexual HIV risk and sexual aggression. CSA is a shared risk factor for sexual aggression and HIV risk behavior through the pathway of anxiety. Thus, anxiety might be one promising target for intervention. Evangeli, Michael; Baker, Laura L E; Pady, Kirsten; Jones, Bethanie; Wroe, Abigail L Current HIV-risk perception refers to the extent to which individuals think they might be HIV-positive. This belief, distinct from the perceived risk about being infected with HIV in the future, is likely to have a range of important consequences. These consequences may include both psychological effects (e.g., impacts on well-being) and behavioural effects (e.g., HIV testing uptake). Given these possible outcomes, and the suggested importance of risk perception in health behaviour models, understanding the behavioural and psychological antecedents of current HIV-risk perception is crucial. This systematic review investigates the relationship between behavioural and psychological factors and current HIV-risk perception (in individuals who are unaware of their actual HIV status). Eight studies were eligible for inclusion in the review (five quantitative and three qualitative studies). Drug risk behaviour and sexual risk behaviour (both self and partner) were often associated with current HIV-risk perception, although other studies failed to show a relationship between one's own sexual risk behaviour and risk perception. Psychological factors were only rarely assessed in relation to current HIV-risk perception. Where these variables were included, there was evidence that experiencing symptoms perceived to be consistent with HIV and prompts to test were associated with increased current HIV-risk perception. These findings are consistent with the Common-Sense Model (CSM) of illness representation and self-regulation. Methodological quality criteria were rarely met for the included studies. In addition, it was often difficult to ascertain whether potentially includable studies were eligible due to imprecise definitions of HIV-risk perception. Research and practice implications are discussed, with particular emphasis on the role of risk appraisals as a potential mediator of the relationship between HIV-risk behaviour, symptoms and current HIV-risk perception. Results indicated that HIV-related knowledge; condom knowledge and risk perception were enhanced by the HIV- related risk reduction programme. However, there is a need for improvement, especially with regard to attitudes towards condoms since some students still had negative attitudes even after the intervention ... Darling, Katharine E A; Diserens, Esther-Amélie; N'garambe, Chantal; Ansermet-Pagot, Anne; Masserey, Eric; Cavassini, Matthias; Bodenmann, Patrick To assess attitudes to HIV risk and acceptability of rapid HIV testing among clients of street-based female sex workers (FSW) in Lausanne, Switzerland, where HIV prevalence in the general population is 0.4%. The authors conducted a cross-sectional study in the red light district of Lausanne for five nights in September of 2008, 2009 and 2010. Clients of FSW were invited to complete a questionnaire in the street assessing demographic characteristics, attitudes to HIV risk and HIV testing history. All clients interviewed were then offered anonymous finger stick rapid HIV testing in a van parked on-site. The authors interviewed 112, 127 and 79 clients in 2008, 2009 and 2010, respectively. All were men, average age 32-37 years old; 40-60% were in a stable relationship. History of unprotected sex was higher with non-commercial partners (33-50%) than with FSW (6-11%); 29-46% of clients had never undergone an HIV test. Anonymous rapid HIV testing was accepted by 45-50% of clients. Out of 109 HIV tests conducted during the three study periods, none was reactive. On-site HIV counselling and testing is acceptable among clients of FSW in this urban setting. These individuals represent an unquantified population, a proportion of which has an incomplete understanding of HIV risk in the face of high-risk behaviour, with implications for potential onward transmission to non-commercial sexual partners. Frye, Victoria; Nandi, Vijay; Egan, James; Cerda, Magdalena; Greene, Emily; Van Tieu, Hong; Ompad, Danielle C.; Hoover, Donald R.; Lucy, Debbie; Baez, Eduardo; Koblin, Beryl A. Understanding what social factors are associated with risk of HIV acquisition and transmission among gay, bisexual and other men who have sex with men (MSM) is a critical public health goal. Experiencing discrimination may increase risk of HIV infection among MSM. This analysis assessed relations between experiences of sexual orientation- and race-based discrimination and sexual HIV risk behavior among MSM in New York City. 1,369 MSM completed a self-administered computerized assessment of past 3-month sexual behavior, experience of social discrimination and other covariates. Regression models assessed relations between recent experience of discrimination and sexual HIV risk behavior. Mean age was 32 years; 32 % were white; 32 % Latino/Hispanic; 25 % African American/Black. Of MSM who self-reported HIV-positive or unknown status (377), 7 % (N = 27) reported having unprotected insertive anal intercourse with an HIV-negative or unknown status partner (“HIV transmission risk”). Of MSM who self-reported HIV-negative status (992), 11 % (110) reported unprotected receptive anal intercourse with an HIV-positive or unknown status partner (“HIV acquisition risk”). HIV acquisition risk was positively associated with sexual orientation-based discrimination in home or social neighborhoods, but not race-based discrimination. We observed that sexual orientation-based discrimination was associated with sexual HIV risk behavior among urban-dwelling MSM. Addressing environmental sources of this form of discrimination, as well as the psychological distress that may result, should be prioritized in HIV prevention efforts. PMID:25381561 Stefani Mariane MA Full Text Available Abstract Background Hepatitis C (HCV and human immunodeficiency virus (HIV infections are a major burden to public health worldwide. Routine antenatal HIV-1 screening to prevent maternal-infant transmission is universally recommended. Our objectives were to evaluate the prevalence of and potential risk factors for HCV and HIV infection among pregnant women who attended prenatal care under the coverage of public health in Central Brazil. Methods Screening and counselling for HIV and HCV infections was offered free of charge to all pregnant women attending antenatal clinic (ANC in the public health system, in Goiania city (~1.1 million inhabitants during 2004–2005. Initial screening was performed on a dried blood spot collected onto standard filter paper; positive or indeterminate results were confirmed by a second blood sample. HCV infection was defined as a positive or indeterminate sample (EIA test and confirmed HCV-RNA technique. HIV infection was defined according to standard criteria. Factors associated with HIV and HCV infections were identified with logistic regression. The number needed to screen (NNS to prevent one case of infant HIV infection was calculated using the Monte Carlo simulation method. Results A total of 28,561 pregnant women were screened for HCV and HIV-1 in ANC. Mean maternal age was 23.9 years (SD = 5.6, with 45% of the women experiencing their first pregnancy. Prevalence of HCV infection was 0.15% (95% CI 0.11%–0.20%, and the risk increased with age (p Conclusion The prevalence of HIV and HCV infections were low among pregnant women, with high acceptability rates in the opt-in strategy in primary care. Older maternal age was a risk factor for HCV and antenatal HCV testing does not fulfill the requirements for screening recommendation. The finding of higher risk of HIV-1 infection among black women despite being in consonance with the HIV-1 ethnic pattern in some American regions cannot be ruled out to be a surrogate AJRH Managing Editor Using the Health Belief Model, the study investigated factors influencing perception of risk of. HIV among adolescents ... Keywords: HIV; risk perception; adolescents; urban slum; Ghana. Résumé ..... World Health Organization. "Global health ... Balogun Joseph A Full Text Available Abstract Background The college environment offers great opportunity for HIV high-risk behaviors, including unsafe sex and multiple partnerships. While the overall incidence of HIV infection has seen some decline in recent years, rates of HIV infection among young adults have not seen a proportionate decline. As in the general population, African American young adults have been disproportionately affected by the HIV/AIDS epidemic. This study examined the sexual risk behaviors and perception of HIV risk of students in a predominantly African American commuter urban university in the Midwest. Methods Students enrolled in randomly selected general education courses completed a paper and pencil survey. Data were collected in Fall 2007, and univariate, bivariate, and multivariate analyses were conducted using SPSS for Windows v.16. Results The sample included 390 students, the majority (83% of whom were never married and 87% were sexually experienced. Among males reporting male partnerships those who used marijuana (OR = 17.5, p = 0.01 and those who used alcohol along with illegal drugs (OR = 8.8, p = 0.03 were significantly more likely to report multiple partnerships. Among females reporting male partnerships, those 30 years and older were significantly less likely (OR = 0.09, p = 0.03 to report having multiple male partners. There were significant differences in condom use last sex (p = 0.01 and consistent condom use (p = 0.002 among the different age groups. Older students were less likely to report condom use. Females age 30 years and older (OR = 3.74, p = 0.05 and respondents age 2029 years (OR = 2.41, p = 0.03 were more likely to report inconsistent condom use than those below 20 years. Marijuana use was correlated with inconsistent condom use (p = 0.02 and alcohol with not using condom last sex among females. Perception of HIV risk was generally poor with 54% of those age 30 years and older, 48.1% of 2029 year olds, and 57.9% of those Kotler, Donald P It has been demonstrated that patients on highly active antiretroviral therapy are at increased risk for developing metabolic abnormalities that include elevated levels of serum triglycerides and low-density lipoprotein cholesterol and reduced levels of high-density lipoprotein cholesterol. This dyslipidemia is similar to that seen in the metabolic syndrome, raising the concern that highly active antiretroviral therapy also potentially increases the risk for cardiovascular complications. This paper reviews the contribution of both HIV infection and the different components of highly active antiretroviral therapy to dyslipidemia and the role of these abnormalities toward increasing the risk of cardiovascular disease in HIV-infected patients; therapeutic strategies to manage these risks are also considered. Objective: The aim of this study was to identify factors affecting HIV risk reduction ... Main outcome measures: Sexual behavior and condom use, knowledge about ... attitudes, normative beliefs, and subjective norms about condoms, HIV/AIDS ... Valera, Pamela; Chang, Yvonne; Lian, Zi HIV prevalence in correctional populations is approximately five times that of the general adult population. This systematic review examines the broad question of HIV prevention and interventions to reduce inmate HIV-related risk behaviors in U.S. federal and state prisons. We conducted a systematic review of multiple databases and Google Scholar to identify behavioral, biomedical, social, and policy studies related to HIV among U.S. prison populations from 1980-2014. Studies were excluded if they did not focus on HIV, prison inmates, if they were conducted outside of the U.S., if they involved juvenile offenders, or if they included post-release outcomes. Twenty-seven articles met the study criteria. Evidence suggests that research related to the HIV care continuum, risk behaviors, gender, prevention (e.g., peer education), and policy are key topics to enhance HIV prevention interventions in the criminal justice system. This review provides a prison-specific overview of HIV in U.S. correctional populations and highlight effective interventions, including inmate peer education. There is an urgent need to continue to implement HIV prevention interventions across all prisons and improve the quality of life among those at heightened risk of HIV infection. Marie Marcelle Deschamps Full Text Available OBJECTIVE: To evaluate novel eligibility criteria and outreach methods to identify and recruit women at high risk of HIV-1 infection in the Caribbean. METHODS: A prospective cohort study was conducted in 2009-2012 among 799 female commercial sex workers in the Dominican Republic, Haiti, and Puerto Rico. Minimum eligibility criteria included exchange of sex for goods, services, or money in the previous 6 months and unprotected vaginal or anal sex with a man during the same period. Sites used local epidemiology to develop more stringent eligibility criteria and recruitment strategies. Participants were asked questions about HIV/AIDS and their level of concern about participating in an HIV vaccine trial. Logistic regression modeling was used to assess predictors of prevalent HIV infection and willingness to participate in a future HIV vaccine study. RESULTS: HIV prevalence at screening was 4.6%. Crack cocaine use [odds ratio (OR = 4.2, 95% confidence interval (CI (1.8-9.0] was associated with and having sex with clients in a hotel or motel [OR = 0.5, CI (0.3-1.0] was inversely associated with HIV infection. A total of 88.9% of enrolled women were definitely or probably willing to participate in a future HIV vaccine trial. CONCLUSIONS: This study indicated that local eligibility criteria and recruitment methods can be developed to identify and recruit commercial sex workers with higher HIV prevalence than the general population who express willingness to join an HIV vaccine trial. Male Partner Risk Behaviors Are Associated With Reactive Rapid HIV Antibody Tests Among Pregnant Mexican Women: Implications for Prevention of Vertical and Sexual HIV Transmission in Concentrated HIV Epidemics. Rivero, Estela; Kendall, Tamil Mexico's policies on antenatal HIV testing are contradictory, and little is known about social and behavioral characteristics that increase pregnant Mexican women's risks of acquiring HIV. We analyzed the association between risk behaviors reported by pregnant women for themselves and their male partners, and women's rapid HIV antibody test results from a large national sample. Three quarters of pregnant women with a reactive test did not report risk behaviors for themselves and one third did not report risk behaviors for themselves or their male partners. In the retrospective case-control analysis, other than reporting multiple sexual partners, reactive pregnant women reported risk behaviors did not differ from nonreactive women's behaviors. However, reactive pregnant women were significantly more likely to have reported risk behaviors for male partners. Our findings support universal offer of antenatal HIV testing and suggest that HIV prevention for women should focus on reducing risk of HIV acquisition within stable relationships. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved. Naranbhai, Vivek; Abdool Karim, Quarraisha; Meyer-Weitz, Anna Homeless youth are at high risk for HIV infection as a consequence of risky sexual behaviour. Interventions for homeless youth are challenging. Assessment of the effectiveness of interventions to modify sexual risk behaviours for preventing HIV in homeless youth is needed. To evaluate and summarize the effectiveness of interventions for modifying sexual risk behaviours and preventing transmission of HIV among homeless youth. We searched electronic databases (CENTRAL, MEDLINE, EMBASE, AIDSearch, Gateway, PsycInfo, LILACS), reference lists of eligible articles, international health agency publication lists, and clinical trial registries. The search was updated January 2010. We contacted authors of published reports and other key role players. Randomised studies of interventions to modify sexual risk behaviour (biological, self-reporting of sexual-risk behaviour or health-seeking behaviour) in homeless youth (12-24 years). Data from eligible studies were extracted by two reviewers. We assessed risk of bias per the Cochrane Collaborations tool. None of the eligible studies reported any primary biological outcomes for this review. Reports of self-reporting sexual risk behaviour outcomes varied across studies precluding calculation of summary measures of effect; we present the outcomes descriptively for each study. We contacted authors for missing or ambiguous data. We identified three eligible studies after screening a total of 255 unique records. All three were performed in the United States of America and recruited substance-abusing male and female adolescents (total N=615) through homeless shelters into randomised controlled trials of independent and non-overlapping behavioural interventions. The three trials differed in theoretical background, delivery method, dosage (number of sessions,) content and outcome assessments. Overall, the variability in delivery and outcomes precluded estimation of summary of effect measures. We assessed the risk of bias to be high for Awad, Susanne F; Chemaitelly, Hiam; Abu-Raddad, Laith J To estimate the annual risk of HIV transmission (ϕ) within HIV sero-discordant couples in 23 countries in sub-Saharan Africa (SSA), by utilizing newly available national population-based data and accounting for factors known to potentially affect this estimation. We used a recently developed pair-based mathematical model that accommodates for HIV-dynamics temporal variation, sexual risk-behavior heterogeneity, and antiretroviral therapy (ART) scale-up. Estimated country-specific ϕ (in absence of ART) ranged between 4.2% (95% uncertainty interval (UI): 1.9%-6.3%) and 47.4% (95% UI: 37.2%-69.0%) per person-year (ppy), with a median of 12.4%. ϕ was strongly associated with HIV prevalence, with a Pearson correlation coefficient of 0.92, and was larger in high- versus low-HIV-prevalence countries. ϕ increased by 1.31% (95% confidence interval: 1.00%-1.55%) ppy for every 1% increase in HIV prevalence. ϕ estimates were similar to earlier estimates, and suggested considerable heterogeneity in HIV infectiousness across SSA. This heterogeneity may explain, partly, the differences in epidemic scales. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved. Shrestha, Roman; Karki, Pramila; Copenhaver, Michael The adoption of mobile technologies for health (mHealth) in healthcare has grown considerably in recent years, but systematic assessment of interest in the use of mHealth in HIV prevention efforts among people who use drugs (PWUD) is lacking. We therefore examined interest in use of mHealth technology in HIV prevention and associated individual-level factors among high-risk PWUD enrolled in methadone maintenance program. A total of 400 HIV-negative PWUD, who reported drug- and/or sex-related risk behaviors completed a standardized assessment using audio computer assisted self-interview (ACASI). Results revealed significant interest in using mHealth-based approaches for specific purposes, including: to receive medication reminders (72.3%), to receive information about HIV risk reduction (65.8%), and to assess HIV risk behaviors (76.5%). Multivariate analysis showed that interest in receiving medication reminders was associated with currently taking medication and being neurocognitively impaired, whereas interest in receiving HIV-risk reduction information was associated with being non-white, married, and perceiving the person was at high-risk for contracting HIV. Similarly, participants' interested in using mHealth for HIV risk behavior assessment was associated with having recently visited a healthcare provider and exhibiting depressive symptoms. Overall, this study demonstrated that high-risk PWUD are interested in using mHealth-based tools as a key part of an HIV prevention approach within a common type of drug treatment settings. Thus, formative research on preferences for design and functionality of mHealth-based HIV prevention tools are now needed, followed by practical development, implementation, and evaluation of these new intervention strategies. Sahlu, T.; Kassa, E.; Agonafer, T.; Tsegaye, A.; Rinke de Wit, T.; Gebremariam, H.; Doorly, R.; Spijkerman, I.; Yeneneh, H.; Coutinho, R. A.; Fontanet, A. L. OBJECTIVES: To describe sexual behaviours, perception of risk of HIV infection, and factors associated with attending HIV post-test counselling (PTC) among Ethiopian adults. METHODS: Data on socio-demographic characteristics, knowledge of HIV infection, sexual history, medical examination, and HIV Grappasonni, I; Paci, P; Mazzucchi, F; Amenta, F Because the nature of their work seafarers spend long periods of time away from their families and therefore represent a group at risk for sexually transmitted diseases, including HIV infection. This paper reports the results of a survey to evaluate awareness and knowledge of the risk of HIV infection among seafarers. Risky behaviours for HIV transmission were also assessed. The survey was conducted using anonymous questionnaires on 197 workers of 9 vessels and 26 office employees of an Italian shipping company (FINAVAL S.p.A., Rome). The respondents considered HIV/AIDS as one of the diseases with a high risk of transmission. Most respondents had a good general knowledge of HIV/AIDS and on the ways of its transmission. However, there is still lack of knowledge on the basics of this disease. On the other hand, in spite of knowledge and awareness about the risks of the disease, only 56.35% of the interviewed crewmembers used protection in sexual intercourse with occasional partners. Compared to data available in literature, the percentage of self-protecting people is increasing, but the number of seafarers exposing themselves to risky behaviours is still high. As expected, condoms are used with regular partners with lower frequency compared to occasional intercourse. The results of this survey indicate that adequate prevention campaigns and major attention paid to seafarers health is useful for stimulating responsible conduct for the prevention of infectious diseases, including HIV infection. Nevertheless, it is still necessary to increase information about the risk of sexually transmitted diseases and how to reduce it. Danielson, Carla Kmett; Walsh, Kate; McCauley, Jenna; Ruggiero, Kenneth J; Brown, Jennifer L; Sales, Jessica M; Rose, Eve; Wingood, Gina M; Diclemente, Ralph J Latent class analysis (LCA) is a useful statistical tool that can be used to enhance understanding of how various patterns of combined sexual behavior risk factors may confer differential levels of HIV infection risk and to identify subtypes among African American adolescent girls. Data for this analysis is derived from baseline assessments completed prior to randomization in an HIV prevention trial. Participants were African American girls (n=701) aged 14-20 years presenting to sexual health clinics. Girls completed an audio computer-assisted self-interview, which assessed a range of variables regarding sexual history and current and past sexual behavior. Two latent classes were identified with the probability statistics for the two groups in this model being 0.89 and 0.88, respectively. In the final multivariate model, class 1 (the "higher risk" group; n=331) was distinguished by a higher likelihood of >5 lifetime sexual partners, having sex while high on alcohol/drugs, less frequent condom use, and history of sexually transmitted diseases (STDs), when compared with class 2 (the "lower risk" group; n=370). The derived model correctly classified 85.3% of participants into the two groups and accounted for 71% of the variance in the latent HIV-related sexual behavior risk variable. The higher risk class also had worse scores on all hypothesized correlates (e.g., self-esteem, history of sexual assault or physical abuse) relative to the lower risk class. Sexual health clinics represent a unique point of access for HIV-related sexual risk behavior intervention delivery by capitalizing on contact with adolescent girls when they present for services. Four empirically supported risk factors differentiated higher versus lower HIV risk. Replication of these findings is warranted and may offer an empirical basis for parsimonious screening recommendations for girls presenting for sexual healthcare services. Tuberculosis (TB) is one of the most dangerous tropical diseases that complicates HIV infection in Nigeria to date. Over two million Nigerians are known to be infected with TB and many more are at risk of the infection. Serum concentrations of total cholesterol and total lipid of 117 female TB patients attending chest clinic at ... Chard, Anna N; Metheny, Nicholas; Stephenson, Rob Rates of new HIV infections continue to increase worldwide among men who have sex with men (MSM). Despite effective prevention strategies such as condoms and pre-exposure prophylaxis (PrEP), low usage of both methods in many parts of the world hinder prevention efforts. An individual's perceptions of the risk of acquiring HIV and the seriousness they afford to seroconversion are important drivers of behavioral risk-taking. Understanding the behavioral factors suppressing the uptake of HIV prevention services is a critical step in informing strategies to improve interventions to combat the ongoing HIV pandemic among MSM. The study aimed to examine cross-national perceptions of HIV/AIDS seriousness, risk, and threat and the association between these perceptions and sociodemographic characteristics, relationships, and high-risk sexual behaviors among MSM. Participants in Australia, Brazil, Canada, Thailand, South Africa, the United Kingdom, and the United States were recruited for a self-administered survey via Facebook (N=1908). Respondents were asked to rate their perceived seriousness from 1 (not at all serious) to 5 (very serious) of contracting HIV, their perceived risk from 1 (no risk) to 10 (very high risk) of contracting HIV based on their current behavior, and their perception of the threat of HIV-measured as their confidence in being able to stay HIV-negative throughout their lifetimes-on a scale from 1 (will not have HIV by the end of his lifetime) to 5 (will have HIV by the end of his lifetime). Covariates included sociodemographic factors, sexual behavior, HIV testing, drug use, and relationship status. Three ordered logistic regression models, one for each outcome variable, were fit for each country. Contracting HIV was perceived as serious (mean=4.1-4.6), but perceptions of HIV risk (mean=2.7-3.8) and threat of HIV (mean=1.7-2.2) were relatively low across countries. Older age was associated with significantly lower perceived seriousness of acquiring Full Text Available Wanjiku Kariuki,1 Jennifer I Manuel,2 Ngaruiya Kariuki,3 Ellen Tuchman,2 Johnnie O'Neal,4 Genevieve A Lalanne2 1University of Texas School of Public Health, Department of Management, Policy, and Community Health, Houston, TX, 2Silver School of Social Work, New York University, New York, 3Internal Medicine Department, Maimonides Medical Center, Brooklyn, 4Department of Social Work, The College of New Rochelle, New Rochelle, NY, USA Abstract: High rates of smoking among persons living with HIV (PLWH may reduce the effectiveness of HIV treatment and contribute to significant morbidity and mortality. Factors associated with smoking in PLWH include mental health comorbidity, alcohol and drug use, health-related quality of life, smoking among social networks and supports, and lack of access to care. PLWH smokers are at a higher risk of numerous HIV-associated infections and non-HIV related morbidity, including a decreased response to antiretroviral treatment, impaired immune functioning, reduced cognitive functioning, decreased lung functioning, and cardiovascular disease. Seventeen smoking cessation interventions were identified, of which seven were randomized controlled trials. The most effective studies combined behavioral and pharmacotherapy treatments that incorporated comprehensive assessments, multiple sessions, and cognitive-behavioral and motivational strategies. Smoking cessation interventions that are tailored to the unique needs of diverse samples and incorporate strategies to reduce the risk of relapse are essential to advancing health outcomes in PLWH. Keywords: HIV, AIDS, smoking, health risks, smoking cessation interventions Mojola, Sanyu A Why are orphaned girls at particular risk of acquiring HIV infection? Using a transition-to-adulthood framework, this study employs qualitative data from Nyanza Province, Kenya, to explore pathways to HIV risk among orphaned and nonorphaned high-school girls. It shows how simultaneous processes such as leaving their parental home, negotiating financial access, and relationship transitions interact to produce disproportionate risk for orphaned girls. The role of financial provision and parental love in modifying girls' trajectories to risk are also explored. A testable theoretical model is proposed based on the qualitative findings, and policy implications are suggested. Mojola, Sanyu A Why are orphaned girls at particular risk of contracting HIV? Using a transition to adulthood framework, this paper uses qualitative data from Nyanza province, Kenya to explore pathways to HIV risk among orphaned and non-orphaned high school girls. I show how co-occurring processes such as residential transition out of the parental home, negotiating financial access and relationship transitions interact to produce disproportionate risk for orphan girls. I also explore the role of financial provision and parental love in modifying girls’ trajectories to risk. I propose a testable theoretical model based on the qualitative findings and suggest policy implications. PMID:21500699 Petoumenos, Kathy; Worm, Signe W; Fontas, Eric HIV-positive patients receiving combination antiretroviral therapy (cART) frequently experience metabolic complications such as dyslipidemia and insulin resistance, as well as lipodystrophy, increasing the risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Rates of DM and other...... glucose-associated disorders among HIV-positive patients have been reported to range between 2 and 14%, and in an ageing HIV-positive population, the prevalence of DM is expected to continue to increase. This study aims to develop a model to predict the short-term (six-month) risk of DM in HIV... Full Text Available Recognizing transgender individuals have a high risk of HIV acquisition, and to inform policies and programming, we conducted an HIV prevalence and risk behaviors survey among transgender individuals in Cambodia.Cross-sectional survey using a respondent driven sampling method with self-administered audio-computer assisted interviews. HIV testing was performed prior to the questionnaire with results available immediately after. Eligible participants were ≥18 years, identified as male at birth and self-identified/expressed as a different gender, and reported having sex with at least one male partner in past year. From six major urban centers of Cambodia, 891 transgender individuals were recruited.The majority of the 891 participants self-identified as third gender or female (94.5%, were young (median age 23, IQR [20-27], had secondary education or higher (80.5%, not married (89.7%, and employed (90.2%. The majority had first sex before 18 years (66.8%, with a male (79.9%, 37.9% having been paid or paying for this first sex. The rate of HIV positivity among participants was found to be 4.15%. Consistent condom use with male and female partners was low with all partner types, but particularly low with male partners when paying for sex (20.3%. The majority of participants reported having experienced discrimination in their lifetime (54.8% and 30.3% had been assaulted. Multivariate analysis revealed that older age (adjusted OR = 14.73 [4.20, 51.67] for age 35-44 and adjusted OR = 7.63 [2.55, 22.81] for age 30-34, only having a primary school education or no schooling at all (adjusted OR = 2.62 [1.18, 5.80], being a resident of Siem Reap (adjusted OR = 7.44 [2.37, 23.29], receiving payment at first sex (adjusted OR = 2.26 [1.00, 5.11], having sex during/after using drugs (adjusted OR = 2.90 [1.09, 7.73], inconsistent condom use during last anal sex (adjusted OR = 3.84 [1.58, 9.33], and reporting low self-esteem (adjusted OR = 3.25 [1.35, 7.85] were ADEDIMEJI, Adebola A.; HOOVER, Donald R.; SHI, Qiuhu; GARD, Tracy; MUTIMURA, Eugene; SINAYOBYE, Jean d’Amour; COHEN, Mardge H.; ANASTOS, Kathryn It is not well understood how infection with HIV and prior experience of sexual violence affects sexual behavior in African women. We describe factors influencing current sexual practices of Rwandan women living with or without HIV/AIDS. By design, 75% of participants were HIV positive and ~50% reported having experienced genocidal rape. Univariate and multivariate logistic regression models were fit to describe demographic and clinical characteristics that influenced sexual behavior in the previous 6 months, condom use, history of transactional sex, and prior infection with a non-HIV sexually transmitted disease. Respondents’ age, where they lived, whether or not they lived with a husband or partner, experience of sexual trauma, CD4 count, CES-D and PTSD scores were strongly associated with risky sexual behavior and infection with non-HIV STI. HIV positive women with a history of sexual violence in the contexts of war and conflict may be susceptible to some high-risk sexual behaviors. PMID:25488169 Sheridan, Sarah; Phimphachanh, Chansy; Chanlivong, Niramonh; Manivong, Sisavath; Khamsyvolsvong, Sod; Lattanavong, Phonesay; Sisouk, Thongchanh; Toledo, Carlos; Scherzer, Martha; Toole, Mike; van Griensven, Frits Men who have sex with men are at high risk for HIV infection. Here we report the results of the first assessment of HIV prevalence and risk behaviour in this group in Vientiane, Lao People's Democratic Republic. Between August and September 2007, 540 men were enrolled from venues around Vientiane, using venue-day-time sampling. Men of Lao nationality, 15 years and over, reporting oral or anal sex with a man in the previous 6 months were eligible for participation. Demographic and socio-behavioural information was self-collected using hand-held computers. Oral fluid was tested for HIV infection. Logistic regression was used to evaluate risk factors for prevalent HIV infection. The median age of participants was 21 years; the HIV prevalence was 5.6%. Of participants, 39.6% reported exclusive attraction to men and 57.6% reported sex with women. Of those who reported having regular and nonregular sexual partner(s) in the past 3 months, consistent condom use with these partners was 14.4 and 24.2%, respectively. A total of 42.2% self-reported any sexually transmitted infection symptoms and 6.3% had previously been tested for HIV. Suicidal ideation was reported by 17.0%, which was the only variable significantly and independently associated with HIV infection in multivariate analysis. Although the HIV prevalence is low compared with neighbouring countries in the region, men who have sex with men in Lao People's Democratic Republic are at high behavioural risk for HIV infection. To prevent a larger HIV epidemic occurrence and transmission into the broader community, higher coverage of HIV prevention interventions is required. Mooij, Sofie H.; van der Klis, Fiona R. M.; van der Sande, Marianne A. B.; Schepp, Rutger M.; Speksnijder, Arjen G. C. L.; Bogaards, Johannes A.; de Melker, Hester E.; de Vries, Henry J. C.; Snijders, Peter J. F.; van der Loeff, Maarten F. Schim Men who have sex with men (MSM), in particular HIV-infected MSM, are at increased risk for diseases related to human papilloma virus (HPV). Our goal was to assess the effect of HIV status on the presence of type-specific antibodies against seven high-risk HPV types in HPV-unvaccinated MSM. Moreover, Nearly 46% of women and 28% of men perceived themselves at medium or high risk of HIV infection. The qualitative and quantitative data show that perception of risk of HIV infection was influenced both by a person's own sexual behaviour and a partner's sexual behaviour. Men were significantly more likely to perceive ... Gupta, M; Kumar, K; Garg, P D The problem of triple diagnosis of HIV, substance abuse and psychiatric disorders is a complex one with difficult solutions. HIV disease progression is affected by substance use as well as psychiatric illness burden due to both direct as well as indirect factors. Continuing substance abuse with poor drug adherence coexists with psychiatric disorders leading to increased morbidity and mortality. A total of 100 HIV positive subjects comprising of two groups each having 50 subjects with and without substance abuse were assessed using detailed history, mental state examination, WHO schedule for clinical assessment in neuropsychiatry (SCAN 2.0) and Beck's Scale for Suicidal Ideation (BSS). Statistical analysis used Chi-Square test, Fischer's exact test, Student's t-test, Pearson's correlation coefficient, univariate and multiple regression analysis, univariate and multiple logistic regression analysis. p-Valueabuse, as compared to subjects without substance use. Suicidal risk was significantly increased (pabuse did not increase the risk. Substance abuse inflicts a much greater burden on HIV positive individuals as compared to subjects without substance use. Concomitant substance abuse resulted in significantly increased duration of illness and psychiatric morbidity. Copyright © 2013 Elsevier B.V. All rights reserved. Kaplan, Rachel; Sevelius, Jae; Ribeiro, Kira According to the ‘Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations’ there are five groups of people at elevated risk of HIV, including ‘transgender women or transgender men who have receptive anal sex with men.’ Although cost effectiveness strategies and best practice lessons recommend targeting specific populations for HIV prevention, existing risk categories lack specificity, and may in fact cause further confusion. Existing categories of risk often perpetuate notions of gender and sexuality that can erroneously exclude, alienate, and stigmatize those who are at the highest risk and thus should be prioritized. We review the troubled history of the MSM category and the problematic conflation of trans feminine individuals and MSM in much of the existing HIV literature, and how this practice has stymied progress in slowing the HIV epidemic in the most at-risk groups, including those who do not fit neatly into binary notions of gender and sex. We draw from examples in the field, specifically among trans feminine people in Beirut and San Francisco, to illustrate the lived experiences of individuals whose identities may not fit into Euro-Atlantic constructs of HIV prevention categories. PMID:26824592 Qi, Jinlei; Zhang, Dapeng; Fu, Xiaojing; Li, Chengmei; Meng, Sining; Dai, Min; Liu, Hui; Sun, Jiangping While the HIV epidemic varies greatly by region and population group throughout China, the HIV incidence among men who have sex with men (MSM) continues to rise at an alarmingly fast pace. We seek to analyze the risk factors associated with HIV infection among MSM recruited from different channels in large urban centers across China, in an attempt to shed light on the design of future targeted intervention strategies. A total of 33,684 MSM from 14 cities and one province were recruited from July to December 2011. Demographic (e.g. age, marital status, education) and behavioral (e.g. condom use, HIV testing history) data were collected using information collection cards. Blood samples were also collected to test for HIV and Syphilis. Participants were recruited from five different channels, and all demonstrated distinct characteristics. The overall rate of positive HIV screening was 6.27% and the rate of syphilis infection was 6.50%. Participants recruited from bathhouses had the highest HIV (11.80%) and syphilis infection rates (11.20%). Participants who were infected with syphilis had the highest HIV-positive screening rate (13.75%; 95% CI OR, 2.33-3.06). living in the southwest region of the country (11.64%; OR=2.76, 95%CI OR 2.19-3.47), Being >20 years of age (Pstrategic interventions for MSM in China. Imlay, Hannah; Kaul, Daniel; Rao, Krishna Clostridium difficile infection is a healthcare-associated infection resulting in significant morbidity. Although immunosuppression is associated with Clostridium difficile infection acquisition and adverse outcomes, the epidemiology of Clostridium difficile infection in HIV-infected patients has been little studied in the era of antiretroviral therapy. This study identifies the risk factors for acquisition of Clostridium difficile infection in HIV-infected patients. A retrospective, propensity score-matched case-control study design was employed, with patients selected from our institution's outpatient HIV clinic. Clostridium difficile infection cases were defined as having positive stool testing plus an appropriate clinical presentation. The propensity score was generated via multiple logistic regression from year of HIV diagnosis, age at first contact, duration of follow-up, gender, and initial CD4 count. The 46 cases included were matched to a total of 180 controls. Prior antibiotic treatment was a significant predictor of Clostridium difficile infection (odds ratio: 13, 95% confidence interval: 3.49-48.8, p Clostridium difficile infection in the multivariable model (odds ratio: 15.17, confidence interval: 1.31-175.9, p = .021). As in the general population, frequent hospitalizations and exposure to antimicrobials are independent predictors of Clostridium difficile infection acquisition in patients with HIV. Additionally, low CD4 count and proton pump inhibitor use are new potentially modifiable variables that can be targeted for prevention of Clostridium difficile infection in future interventional studies. Bailey, A.; Hutter, I. Behaviour change models in HIV prevention tend to consider that risky sexual behaviours reflect risk assessments and that by changing risk assessments behaviour can be changed. Risk assessment is however culturally constructed. Individuals use heuristics or bounded cognitive devices derived from Haghighat, Roxanna; Cluver, Lucie Background Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Methods Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10–24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted. Results 610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n = 35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored HIV-positive status and accessing HIV support groups were associated with reduced sexual risk-taking. Of the four intervention studies (three RCTs), three evaluated group-based interventions, and one evaluated an individual-focused combination intervention. Three of the interventions were effective at reducing sexual risk-taking, with one Mwangala, Sheila Monde Background Perception of risk of HIV infection has been suggested to be an important area of study as it can be an assumed to be an indicator of one’s understanding of susceptibility to HIV infection and a precursor to behavioral change, which could determine future decision making regarding risk taking. Studies that have examined perception of HIV risk and its determinants still remain limited. Zambia is among the worst affected countries by the HIV pandemic in the sub-Sahara African r... Slaymaker, Emma; Zaba, Basia Correct and consistent condom use can prevent susceptible people from acquiring HIV infection. However, in many countries repeated cross-sectional studies reveal a trend of increasing prevalence of HIV infection alongside an increase in reported condom use. Changes in sexual behaviour that reduce the number of new HIV infections will not become apparent through changes in HIV prevalence until some time after the behaviour change takes place. Limitations in the data used to assess condom use may also explain the concurrent increases in condom use and HIV prevalence. One common indicator of condom use, the UNGASS indicator (condom use at last higher risk sex of those aged 15-24), has been chosen to illustrate how changes in the proportion of people who report using condoms do not always explain changes in the size of the group who had high risk behaviour. Indicators based on the proportion of the whole population who have sex without using a condom would be better measures of the size of the group at highest risk of HIV infection. Zirpoli, Josefina Cláudia; Lacerda, Heloisa Ramos; Albuquerque, Valéria Maria Gonçalves de; Albuquerque, Maria de Fátima Pessoa Militão de; Miranda Filho, Demócrito de Barros; Monteiro, Verônica Soares; de Barros, Isly Lucena; de Arruda Junior, Evanízio Roque; Montarroyos, Ulisses Ramos; Ximenes, Ricardo Arraes de Alencar The incidence of ischemic heart disease is higher in patients with HIV/AIDS. However, the frequency of angina pectoris in these patients is still not known. Literature about this subject is still scarce. To evaluate the prevalence of angina pectoris and risk factors for coronary disease and to examine the association between traditional risk factors and HIV-related risk factors and angina pectoris. An epidemiological cross-sectional study, analyzed as case-control study, involving 584 patients with HIV/AIDS. Angina pectoris was identified by Rose questionnaire, classified as definite or possible. Information regarding risk factors was obtained through a questionnaire, biochemical laboratory tests, medical records and anthropometric measures taken during consultations at AIDS treatment clinics in Pernambuco, Brazil, from June 2007 to February 2008. To adjust the effect of each factor in relation to others, multiple logistic regression was used. There was a preponderance of men (63.2%); mean ages were 39.8 years for men, 36.8 years for women. The prevalence of definite and possible angina were 11% and 9.4%, respectively, totaling 20.4%, with independent associations between angina and smoking (OR = 2.88; 95% CI: 1.69-4.90), obesity (OR = 1.62; 95% CI: 0.97-2.70), family history of heart attack (OR = 1.70; 95% CI: 1.00-2.88), low schooling (OR = 2.11; 95% CI: 1.24-3.59), and low monthly income (OR = 2.93; 95% CI: 1.18-7.22), even after adjustment for age. This study suggests that angina pectoris is underdiagnosed, even in patients with medical monitoring, revealing lost opportunities in identification and prevention of cardiovascular morbidity. Full Text Available Recent HIV research suggested assessing adverse childhood experiences (ACEs as contributing factors of HIV risk behaviors. However, studies often focused on a single type of adverse experience and very few utilized population-based data. This population study examined the associations between ACE (individual and cumulative ACE score and HIV risk behaviors. We analyzed the 2012 Behavioral Risk Factor Surveillance Survey (BRFSS from 5 states. The sample consisted of 39,434 adults. Eight types of ACEs that included different types of child abuse and household dysfunctions before the age of 18 were measured. A cumulative score of ACEs was also computed. Logistic regression estimated of the association between ACEs and HIV risk behaviors using odds ratio (OR with 95% confidence intervals (CIs for males and females separately. We found that ACEs were positively associated with HIV risk behaviors overall, but the associations differed between males and females in a few instances. While the cumulative ACE score was associated with HIV risk behaviors in a stepwise manner, the pattern varied by gender. For males, the odds of HIV risk increased at a significant level as long as they experienced one ACE, whereas for females, the odds did not increase until they experienced three or more ACEs. Future research should further investigate the gender-specific associations between ACEs and HIV risk behaviors. As childhood adversities are prevalent among general population, and such experiences are associated with increased risk behaviors for HIV transmission, service providers can benefit from the principles of trauma-informed practice. Full Text Available The development of resistant strains of HIV is the most significant barrier to effective long-term treatment of HIV infection. The most common causes of resistance development are patient noncompliance and pre-existence of resistant strains. In this paper, methods of antiviral regimen switching are developed that minimize the risk of pre-existing resistant virus emerging during therapy switches necessitated by virological failure. Two distinct cases are considered; a single previous virological failure and multiple virological failures. These methods use optimal control approaches on experimentally verified mathematical models of HIV strain competition and statistical models of resistance risk. It is shown that, theoretically, order-of-magnitude reduction in risk can be achieved, and multiple previous virological failures enable greater success of these methods in reducing the risk of subsequent treatment failures. Petoumenos, Kathy; Worm, Signe Westring; Fontas, Eric Introduction: HIV-positive patients receiving combination antiretroviral therapy (cART) frequently experience metabolic complications such as dyslipidemia and insulin resistance, as well as lipodystrophy, increasing the risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Rates of DM ......). Factors predictive of DM included higher glucose, body mass index (BMI) and triglyceride levels, and older age. Among HIV-related factors, recent CD4 counts of...... and other glucose-associated disorders among HIV-positive patients have been reported to range between 2 and 14%, and in an ageing HIV-positive population, the prevalence of DM is expected to continue to increase. This study aims to develop a model to predict the short-term (six-month) risk of DM in HIV... Khumsaen, Natawan; Stephenson, Rob This study examined the relationships of HIV/AIDS beliefs, self-efficacy for AIDS preventive behaviors, perception of HIV as a chronic disease, and HIV risk behaviors among young Thai men who have sex with men. Participants were recruited for a self-administered anonymous survey through Facebook. Logistic regression analysis was used to identify factors associated with each of four HIV risk behavior outcomes. Factors associated with sexual risk behaviors included age (18 and 21 years), having a current regular male partner, self-efficacy for AIDS preventive behaviors (self-efficacy in refusing sexual intercourse, self-efficacy in questioning potential sex partners, and self-efficacy in condom use), AIDS health belief (perceived susceptibility to HIV/AIDS, perceived severity of HIV/AIDS, perceived barriers to condom use, and cues to action for HIV/AIDS prevention), and perception of HIV/AIDS as a chronic disease (perceived HIV sero-status disclosure). Knowledge generated from this study has the potential to inform prevention messages for young Thai MSM. Rasmussen, Dlama Nggida; Wejse, Christian; Larsen, Olav Introduction: Male circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified by socio-cultural factors such as the timing and method (medical and traditional) of circumcision. Understanding regional variations in circumcision practices and their relationship to HIV...... is crucial and can increase insight into the HIV epidemic in Africa. Methods: We used data from two retrospective HIV surveys conducted in Guinea- Bissau from 1993 to 1996 (1996 cohort) and from 2004 to 2007 (2006 cohort). Multivariate logistical models were used to investigate the relationships between HIV...... risk and circumcision status, timing, method of circumcision, and socio-demographic factors. Results: MC was protective against HIV infection in both cohorts, with adjusted odds ratios (AORs) of 0.28 (95% CI 0.12-0.66) and 0.30 (95% CI 0.09-0.93), respectively. We observed that post-pubertal (≥13 years... Isler, M. Roman; Golin, C.; Wang, J.; Hughes, J.; Justman, J.; Haley, D.; Kuo, I.; Adimora, A.; Chege, W.; Hodder, S. Identifying venues where women meet sexual partners, particular partners who increase women's risk of acquiring HIV, could inform prevention efforts. We categorized venues where women enrolled in HPTN 064 reported meeting their last three sex partners as: (1) Formal, (2) Public, (3) Private, and (4) Virtual spaces. We used multinomial logistic regression to assess the association between these venues and women's individual characteristics and reports of their partners' HIV risk characteristic... El-Bassel, Nabila; Jemmott, John B; Bellamy, Scarlett L; Pequegnat, Willo; Wingood, Gina M; Wyatt, Gail E; Landis, J Richard; Remien, Robert H Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention's effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions. Fisher, Michael P.; Ramchand, Rajeev; Bana, Sarah; Iguchi, Martin Y. Objective: This study examined substance use (intended and actual), unprotected sex, and HIV disclosure practices (disclosure and questioning) among HIV-positive men who have sex with men (MSM) at two party-oriented vacations, where substance use and sexual risk may be heightened. Method: A random sample of 489 MSM attending one of two party-oriented vacations participated in PartyIntents, a short-term longitudinal survey. Nearly half (47%) completed a follow-up assessment at the event or online for up to 2 weeks after the event. We examined rates of baseline intentions to use substances, actual substance use, and unprotected intercourse among HIV-positive men in attendance.Rates among HIV-negative men were estimated for comparison. Multiple logistic regression was used to assess the impact of illegal drug use and HIV status on unprotected anal intercourse (UAI). Results: HIV-positive attendees (17%) were significantly more likely than HIV-negative attendees to use nitrite inhalants (or “poppers”) (24.3% vs. 10.7%). HIV-positive attendees were also significantly more likely to have insertive UAI (64.3% vs. 34.1%) and receptive UAI (68.8% vs. 22.2%). Multivariate models showed associations between HIV status and illegal drug use with UAI (for HIV status, odds ratio [OR] = 4.5, p = .001; for any illegal drug use, OR = 16.4, p < .001). There was no evidence that the influence of drug use moderated risk by HIV status. Rates of HIV disclosure and questioning did not differ by HIV status. Conclusions: HIV-positive men attending these events engaged in higher rates of illegal drug use and sexual risk than HIV-negative men. Prevention campaigns targeting MSM at high-risk events should include messages geared toward HIV-positive men. PMID:23200162 HIV risk behavior was significantly related to alcohol use (P = 0.03). Conclusion: Mental health services provide an important context for HIV/AIDS interventions in resource‑constrained countries like Nigeria. Keywords: Human immuno virus, Mental health, Psychiatric patients, Risk behavior, Severe mental disorders ... Helleberg, Marie; Gerstoft, Jan; Afzal, Shoaib BACKGROUND: The relative impact of immune deficiency and lifestyle-related factors on risk of cancer in the HIV-infected population is controversial. We aimed to estimate the population-attributable fractions (PAFs) associated with smoking, being HIV-infected and with immune deficiency. METHODS...... of cancer associated with smoking and with being HIV-infected were 27 and 49%, respectively. For cancers not strongly related to smoking or viral infections, the PAFs associated with being HIV-infected and with immune deficiency were 0%. CONCLUSION: The risk of cancer is increased in HIV patients compared......: In a Danish, nationwide, population-based cohort study (1995-2011), incidences of cancer were compared between an HIV-infected cohort and a population-based matched cohort in analyses stratified on cancer category, smoking status and for HIV patients: low CD4 cell count. RESULTS: We included 3503 HIV patients... Glory O. Atilola Full Text Available Summary: Objectives: According to the last HIV surveillance survey conducted in 2008, the overall National HIV prevalence in Nigeria stands at 4.6%. Recent studies and estimates by UNAIDS/WHO show higher prevalences in some selected states in Nigeria. The focus of this study is to determine the prevalence, risk behaviour, attitude and knowledge of HIV among long-distance heavy-truckers from a cross-sectional survey conducted in the south-west Nigeria. Methods: Four major truck terminals (devoted to long-distance trips in south western Nigeria were identified. A cross-sectional survey was conducted using a total sample size of 451 truckers who consented to be interviewed. A questionnaire (in English, Hausa and Yoruba languages for data collection on the socio-demographic, risk behaviour, attitude and knowledge of HIV from the truckers was also designed. The multiple logistic regressions analysis was used to assess the association between some selected variables and factors. Results: Only 164 (36.4% participants out of the study population of 451 were tested for HIV (due to limited test facilities and consent and the prevalence of HIV antibodies among the truckers was found to be 2.4% (4/164 with all the infected individuals being within 21–30 years of age. 309 (68.1% of the respondents admitted that they were at risk of contracting HIV while a total of 249 (55.3% admitted that they had more than one sexual partners. In addition, while 392 (86.9% said it was important for them to know their HIV status, 88 (19.5% said that they would commit suicide should they test positive for HIV. Conclusion: Although the HIV prevalence rate observed among the tested participants (2.4% was lower than the overall national prevalence (4.6%, the result calls for concern as it showed that the population of truckers is a potential high risk group in Nigeria. Also, the mobile nature of this high-risk group has made getting HIV/AIDS awareness messages across to them a Davis, Mark; Hart, Graham; Bolding, Graham; Sherr, Lorraine; Elford, Jonathan This paper addresses how London gay men use the internet to meet sexual partners, or for e-dating. Based on qualitative interviews conducted face-to-face or via the internet, this research develops an account of how information technologies mediate the negotiation of identity and risk in connection with sexual practice. E-dating itself is a bricolage, or heterogeneous DIY practice of internet-based-communication (IBC). A central aspect of IBC is "filtering" in and out prospective e-dates based on the images and texts used to depict sexual identities. Interpretations and depictions of personal HIV risk management approaches in IBC are framed by the meanings of different identities, such as the stigma associated with being HIV positive. This paper argues for a sexualities perspective in a theory of network society. Further, HIV prevention in e-dating can potentially be addressed by considering the interplay of the HIV prevention imperatives associated with different HIV serostatus identities. There is a case for encouraging more explicit IBC about risk in e-dating and incorporating the expertise of e-daters in prevention activity. There is also a need to rethink traditional conceptions of risk management in HIV prevention to make space for the risk management bricolage of network society. Stephanie L Sansom Full Text Available BACKGROUND: HIV incidence was substantially lower among circumcised versus uncircumcised heterosexual African men in three clinical trials. Based on those findings, we modeled the potential effect of newborn male circumcision on a U.S. male's lifetime risk of HIV, including associated costs and quality-adjusted life-years saved. METHODOLOGY/PRINCIPAL FINDINGS: Given published estimates of U.S. males' lifetime HIV risk, we calculated the fraction of lifetime risk attributable to heterosexual behavior from 2005-2006 HIV surveillance data. We assumed 60% efficacy of circumcision in reducing heterosexually-acquired HIV over a lifetime, and varied efficacy in sensitivity analyses. We calculated differences in lifetime HIV risk, expected HIV treatment costs and quality-adjusted life years (QALYs among circumcised versus uncircumcised males. The main outcome measure was cost per HIV-related QALY saved. Circumcision reduced the lifetime HIV risk among all males by 15.7% in the base case analysis, ranging from 7.9% for white males to 20.9% for black males. Newborn circumcision was a cost-saving HIV prevention intervention for all, black and Hispanic males. The net cost of newborn circumcision per QALY saved was $87,792 for white males. Results were most sensitive to the discount rate, and circumcision efficacy and cost. CONCLUSIONS/SIGNIFICANCE: Newborn circumcision resulted in lower expected HIV-related treatment costs and a slight increase in QALYs. It reduced the 1.87% lifetime risk of HIV among all males by about 16%. The effect varied substantially by race and ethnicity. Racial and ethnic groups who could benefit the most from circumcision may have least access to it due to insurance coverage and state Medicaid policies, and these financial barriers should be addressed. More data on the long-term protective effect of circumcision on heterosexual males as well as on its efficacy in preventing HIV among MSM would be useful. To study demographic, social, behavioural and biological variables as risk factors for HIV infection among men and women in India, we used data from the cross-sectional, population-based National Family Health Survery (NFHS)-3 2005-06. During the survey, 52,853 women aged 15-49 years and 50,093 men aged 15-54 years gave consent to anonymous HIV testing. HIV serostatus data for men and women were analysed for their relationships to key characteristics using bivariate and multivariate techniques. In the analysis of the study sample, in both men and women the ages of highest risk for HIV were between 25 and 34 years. Married, widowed, divorced women and men had higher odds of being HIV-positive; employed individuals also had a higher risk of being HIV-positive (odds ratio [OR] = 1.89 and 2.89, respectively). Muslim women had a lower risk (OR 0.23). Wealth was not found to be associated with HIV serostatus among men in our study sample. In women, a history of genital ulcer or sore significantly increased their risk. Circumcised men were found to be at a lower risk for HIV infection. HIV is a multi-dimensional epidemic, with demographic, residential, social, biological and behavioural factors exerting influence on individual probability of becoming infected with HIV. Costenbader, Elizabeth C; Astone, Nan M; Latkin, Carl A While studies of the social networks of injection drug users (IDUs) have provided insight into how the structures of interpersonal relationships among IDUs affect HIV risk behaviors, the majority of these studies have been cross-sectional. The present study examined the dynamics of IDUs' social networks and HIV risk behaviors over time. Using data from a longitudinal HIV-intervention study conducted in Baltimore, MD, this study assessed changes in the composition of the personal networks of 409 IDUs. We used a multi-nomial logistic regression analysis to assess the association between changes in network composition and simultaneous changes in levels of injection HIV risk behaviors. Using the regression parameters generated by the multi-nomial model, we estimated the predicted probability of being in each of four HIV risk behavior change groups. Compared to the base case, individuals who reported an entirely new set of drug-using network contacts at follow-up were more than three times as likely to be in the increasing risk group. In contrast, reporting all new non-drug-using contacts at follow-up increased the likelihood of being in the stable low-risk group by almost 50% and decreased the probability of being in the consistently high-risk group by more than 70%. The findings from this study show that, over and above IDUs' baseline characteristics, changes in their personal networks are associated with changes in individuals' risky injection behaviors. They also suggest that interventions aimed at reducing HIV risk among IDUs might benefit from increasing IDUs' social contacts with individuals who are not drug users. Kenneth K Mugwanya Full Text Available The ultimate success of medical male circumcision for HIV prevention may depend on targeting male infants and children as well as adults, in order to maximally reduce new HIV infections into the future.We conducted a cross-sectional study among heterosexual HIV serodiscordant couples (a population at high risk for HIV transmission attending a research clinic in Kampala, Uganda on perceptions and attitudes about medical circumcision for male children for HIV prevention. Correlates of willingness to circumcise male children were assessed using generalized estimating equations methods.318 HIV serodiscordant couples were interviewed, 51.3% in which the female partner was HIV uninfected. Most couples were married and cohabiting, and almost 50% had at least one uncircumcised male child of ≤18 years of age. Overall, 90.2% of male partners and 94.6% of female partners expressed interest in medical circumcision for their male children for reduction of future risk for HIV infection, including 79.9% of men and 87.6% of women who had an uncircumcised male child. Among both men and women, those who were knowledgeable that circumcision reduces men's risk for HIV (adjusted prevalence ratio [APR] 1.34 and 1.14 and those who had discussed the HIV prevention effects of medical circumcision with their partner (APR 1.08 and 1.07 were significantly (p≤0.05 more likely to be interested in male child circumcision for HIV prevention. Among men, those who were circumcised (APR 1.09, p = 0.004 and those who were HIV seropositive (APR 1.09, p = 0.03 were also more likely to be interested in child circumcision for HIV prevention.A high proportion of men and women in Ugandan heterosexual HIV serodiscordant partnerships were willing to have their male children circumcised for eventual HIV prevention benefits. Engaging both parents may increase interest in medical male circumcision for HIV prevention. Okumu, Moses; Mengo, Cecilia; Ombayo, Bernadette; Small, Eusebius Teen dating violence (TDV), bullying, and HIV risk behaviors are public health concerns that impact adolescents in the United States. National estimates reveal high rates of these risk behaviors among high school students. Based on theoretical and empirical evidence, we hypothesized that experiencing teen dating violence (sexual and physical) would mediate the impact of bullying on HIV risk. Data were from the 2013 National Youth Behavior Risk Surveillance Survey (YRBSS) among students who answered questions on bullying, TDV, and HIV risk (N = 13,571). The YRBSS is conducted biennially among 9th- to 12th-grade students nationally. We used multiple regression analysis and Hayes' SPSS process macro to examine the 2 study hypotheses. Findings from bivariate analysis suggest an association between bullying and HIV risk. The study also found associations between physical, sexual teen dating violence and HIV risk. Results also indicate that both physical and sexual teen dating violence mediate the association between bullying and HIV risk. Our findings suggest that multidimensional interventions should be developed to reduce the rate of teen dating violence and combat bullying as a preventative method for HIV risk among high school students. © 2017, American School Health Association. Shaw, Stacey A; McCrimmon, Tara; Mergenova, Gaukhar; Sultangaliyeva, Alma; El-Bassel, Nabila HIV incidence is increasing in Central Asia, where migrant workers experience risks for acquiring sexually transmitted HIV. As a social and structural factor that may influence perceptions and behavior, we examine how Islam shapes HIV risk and protection. Phenomenological qualitative interviews examine religion and contexts of HIV risk among 48 male Central Asian migrant workers residing in Almaty, Kazakhstan. Men described nonvaginal sex, alcohol use, premarital sex, and extramarital sex as forbidden or frowned upon. Religious networks were unlikely to discuss HIV risks, and some men viewed religious affiliation or practices as protective. Marital practices including neke (religious marriage), polygyny, and bride kidnapping may be linked to risk. Findings suggest adhering to Islamic ideals may be protective for some men, but for others, assumptions of protection may enhance risk. HIV prevention strategies among Central Asian migrants may be strengthened by attention to religious and cultural understandings of risk and protection. Chen, Marcelo; Wong, Wing-Wai; Law, Matthew G.; Kiertiburanakul, Sasisopin; Yunihastuti, Evy; Merati, Tuti Parwati; Lim, Poh Lian; Chaiwarith, Romanee; Phanuphak, Praphan; Lee, Man Po; Kumarasamy, Nagalingeswaran; Saphonn, Vonthanak; Ditangco, Rossana; Sim, Benedict L. H.; Nguyen, Kinh Van; Pujari, Sanjay; Kamarulzaman, Adeeba; Zhang, Fujie; Pham, Thuy Thanh; Choi, Jun Yong; Oka, Shinichi; Kantipong, Pacharee; Mustafa, Mahiran; Ratanasuwan, Winai; Durier, Nicolas; Chen, Yi-Ming Arthur Background We assessed the effects of hepatitis B (HBV) or hepatitis C (HCV) co-infection on outcomes of antiretroviral therapy (ART) in HIV-infected patients enrolled in the TREAT Asia HIV Observational Database (TAHOD), a multi-center cohort of HIV-infected patients in the Asia-Pacific region. Methods Patients testing HBs antigen (Ag) or HCV antibody (Ab) positive within enrollment into TAHOD were considered HBV or HCV co-infected. Factors associated with HBV and/or HCV co-infection were assessed by logistic regression models. Factors associated with post-ART HIV immunological response (CD4 change after six months) and virological response (HIV RNA <400 copies/ml after 12 months) were also determined. Survival was assessed by the Kaplan-Meier method and log rank test. Results A total of 7,455 subjects were recruited by December 2012. Of patients tested, 591/5656 (10.4%) were HBsAg positive, 794/5215 (15.2%) were HCVAb positive, and 88/4966 (1.8%) were positive for both markers. In multivariate analysis, HCV co-infection, age, route of HIV infection, baseline CD4 count, baseline HIV RNA, and HIV-1 subtype were associated with immunological recovery. Age, route of HIV infection, baseline CD4 count, baseline HIV RNA, ART regimen, prior ART and HIV-1 subtype, but not HBV or HCV co-infection, affected HIV RNA suppression. Risk factors affecting mortality included HCV co-infection, age, CDC stage, baseline CD4 count, baseline HIV RNA and prior mono/dual ART. Shortest survival was seen in subjects who were both HBV- and HCV-positive. Conclusion In this Asian cohort of HIV-infected patients, HCV co-infection, but not HBV co-infection, was associated with lower CD4 cell recovery after ART and increased mortality. PMID:26933963 Zarrabi, N.; Prosperi, M.C.F.; Belleman, R.G.; Di Giambenedetto, S.; Fabbiani, M.; De Luca, A.; Sloot, P.M.A. Reconstruction of HIV transmission networks is important for understanding and preventing the spread of the virus and drug resistant variants. Mixing risk groups is important in network analysis of HIV in order to assess the role of transmission between risk groups in the HIV epidemic. Most of the Martin, Eileen; Gonzalez, Raul; Vassileva, Jasmin; Maki, Pauline M; Bechara, Antoine; Brand, Matthias HIV+ individuals with and without substance use disorders make significantly poorer decisions when information about the probability and magnitude of wins and losses is not available. We administered the Game of Dice Task, a measure of decision making under risk that provides this information explicitly, to 92 HIV+ and 134 HIV- substance-dependent men and women. HIV+ participants made significantly poorer decisions than HIV- participants, but this deficit appeared more prominent among HIV+ women. These data indicate that decision making under risk is impaired among HIV+ substance-dependent individuals (SDIs). Potential factors for the HIV+ women's relatively greater impairment are discussed. Ahaneku, Hycienth; Ross, Michael W; Nyoni, Joyce E; Selwyn, Beatrice; Troisi, Catherine; Mbwambo, Jessie; Adeboye, Adeniyi; McCurdy, Sheryl Studies have shown high rates of depression among men who have sex with men (MSM) in developed countries. Studies have also shown association between depression and HIV risk among MSM. However, very little research has been done on depression among African MSM. We assessed depression and HIV risk among a sample of MSM in Tanzania. We reviewed data on 205 MSM who were recruited from two Tanzanian cities using the respondent driven sampling method. Demographic and behavioral data were collected using a structured questionnaire. HIV and sexually transmitted infections data were determined from biological tests. Depression scores were assessed using the Patient Health Questionnaire (PHQ-9). For the analysis, depression scores were dichotomized as depressed (PHQ > 4) and not depressed (PHQ ≤ 4). Bivariate and multivariable Poisson regression analyses were conducted to assess factors associated with depression. The prevalence of depression in the sample was 46.3%. The mean (±SD) age of the sample was 25 (±5) years. In bivariate analysis, depression was associated with self-identifying as gay (p = .001), being HIV positive (p Depression was also associated with sexual (p = .007), physical (p = .003) and verbal (p depression was associated with verbal abuse (APR = 1.91, CI = 1.30-2.81). Depression rates were high among MSM in Tanzania. It is also associated with abuse, HIV and HIV risk behaviors. Thus, reducing the risk of depression may be helpful in reducing the risk of HIV among MSM in Africa. We recommend the colocation of mental health and HIV preventive services as a cost-effective means of addressing both depression and HIV risk among MSM in Africa. Stein, Judith A; Nyamathi, Adeline; Ullman, Jodie B; Bentler, Peter M Studies among normative samples generally demonstrate a positive impact of marriage on health behaviors and other related attitudes. In this study, we examine the impact of marriage on HIV/AIDS risk behaviors and attitudes among impoverished, highly stressed, homeless couples, many with severe substance abuse problems. A multilevel analysis of 368 high-risk sexually intimate married and unmarried heterosexual couples assessed individual and couple-level effects on social support, substance use problems, HIV/AIDS knowledge, perceived HIV/AIDS risk, needle-sharing, condom use, multiple sex partners, and HIV/AIDS testing. More variance was explained in the protective and risk variables by couple-level latent variable predictors than by individual latent variable predictors, although some gender effects were found (e.g., more alcohol problems among men). The couple-level variable of marriage predicted lower perceived risk, less deviant social support, and fewer sex partners but predicted more needle-sharing. Matza, Louis S; Chung, Karen C; Kim, Katherine J; Paulus, Trena M; Davies, Evan W; Stewart, Katie D; McComsey, Grace A; Fordyce, Marshall W Despite benefits of antiretroviral therapies (ART), people with HIV infection have increased risk of cardiovascular disease, kidney disease, and low bone mineral density. Some ARTs increase risk of these events. The purpose of this study was to examine patients' perspectives of these risks and estimate health state utilities associated with these risks for use in cost-utility models. Qualitative thematic analysis was conducted to examine messages posted to the POZ/AIDSmeds Internet community forums, focusing on bone, kidney, and cardiovascular side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off interviews with general population participants in the UK. Qualitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4% female; mean age 44.6 years). The mean utility of the HIV health state (virologically suppressed, treated with ART) was 0.86. Adding a description of risk resulted in statistically significant disutility (i.e., utility decreases): renal risk (disutility = -0.02), bone risk (-0.03), and myocardial infarction risk (-0.05). Patient concerns and treatment decisions were documented via qualitative analysis of Internet forum discussions, and the impact of these concerns was quantified in terms of health state utilities. The resulting disutilities may be useful for differentiating among ARTs in economic modeling of treatment for patients with HIV. Douglas, SD; Rudy, B; Muenz, L; Starr, SE; Campbell, DE; Wilson, C; Holland, C; Crowley-Nowick, P; Vermund, SH Background: The capacity of the immune system of adolescents to generate and repopulate naive and memory cell populations under conditions of normal homeostasis and human immunodeficiency virus (HIV) infection is largely unknown. Objective: To assess lymphocyte subsets in HIV-infected and high-risk Department of Microbiology and Immunology. Faculty of Medicine, . Muhimbili University College of Health Sciences,. P. O. Box 65001, Dar es Salaam. Tanzania. .... low occupational risk of acquiring. HIV infection despite frequent occupational exposre to persons at increased risk for HIV infection. (12). As a matter of fact, ... Brooks, Ronald A; Landovitz, Raphael J; Kaplan, Rachel L; Lieber, Eli; Lee, Sung-Jae; Barkley, Thomas W The objective of this mixed methods study was to examine current sexual risk behaviors, acceptability and potential adoption of pre-exposure prophylaxis (PrEP) for HIV prevention, and sexual behavior intentions with PrEP adoption among HIV-negative gay and bisexual men (GBM) in HIV serodiscordant relationships. A multiracial/ethnic sample of 25 HIV-negative GBM in serodiscordant relationships completed a qualitative interview and a brief interviewer-administered survey. A modified grounded theory approach was used to identify key themes relating to acceptability and future adoption of PrEP. Participants reported engaging in sexual risk behaviors that place them at risk for HIV infection. Participants also reported a high level of acceptability for PrEP and willingness to adopt PrEP for HIV prevention. Qualitative themes explaining future PrEP adoption included: (1) the opportunity to engage in sex using a noncondom HIV prevention method, (2) protection from HIV infection, and (3) less anxiety when engaging in sex with an HIV-positive partner. Associated with the future adoption of PrEP, a majority (64%) of participants indicated the likelihood for an increase in sexual risk behaviors and a majority (60%) of participants also indicated the likelihood for a decrease or abandonment of condom use, both of which are in contrast to the findings from the large iPrEx study. These findings suggest that the use of PrEP by HIV-negative GBM in serodiscordant relationships carries with it the potential for risk compensation. The findings suggest that PrEP only be offered as part of a comprehensive HIV prevention strategy that includes ongoing risk reduction counseling in the delivery of PrEP to help moderate risk compensation. Cené, Crystal W; Akers, Aletha Y; Lloyd, Stacey W; Albritton, Tashuna; Powell Hammond, Wizdom; Corbie-Smith, Giselle African Americans (AA) and rural communities often suffer disproportionately from poorer health. Theory-guided research examining how individual- and community-level factors influence health behaviors and contribute to disparities is needed. To understand how a social network model that captures the interplay between individual and community factors might inform community-based interventions to reduce HIV risk in rural AA communities. Qualitative study. Eleven focus groups with 38 AA 16-24 year olds, 42 adults over age 25, and 13 formerly incarcerated individuals held in community settings in two rural, predominantly AA counties in North Carolina. Thirty-seven semi-structured interviews with multiethnic key informants. Semi-structured interviews and focus groups with open-ended questions assessed a) perceptions of multi-level HIV risk determinants from a social network model (individual, interpersonal, social, economic, political and structural) identified through literature review and b) community needs and assets affecting local HIV rates. Qualitative data was analyzed using directive content analysis guided by a social network model. We identified four themes regarding the interaction between individuals and their communities that mediate HIV risk: interpersonal processes, community structural environment, social disorder, and civic engagement. Communities were characterized as having a high degree of cohesiveness, tension, and HIV-related stigma. The community structural environment-characterized by neighborhood poverty, lack of skilled jobs, segregation, political disenfranchisement and institutional racism-was felt to reduce the availability and accessibility of resources to combat HIV. Adults noted an inability to combat social problems due to social disorder, which fuels HIV risk behaviors. Civic engagement as a means of identifying community concerns and developing solutions is limited by churches' reluctance to address HIV-related issues. To combat HIV Sigrid J A Lindbom Full Text Available This qualitative study explores former prison inmates' perceptions and attitudes towards HIV risk inside Swedish prisons.In 2014, eight semi-structured interviews were conducted with former male prisoners to gain a deeper understanding of situations perceived to be associated with risk of HIV transmission. The material gathered from the interviews was analyzed by manifest and latent qualitative content analysis.The findings revealed that risky behavioral practices, such as sharing needles, unprotected sexual activity, and lack of openness about HIV status represented potential health threats with regard to the risk of HIV transmission.Evidence from the study indicates that educational interventions regarding HIV and the transmission routes are required for HIV prevention in Swedish prisons. Full Text Available Judith Lammers,1 Sweder JG van Wijnbergen,2 Daan Willebrands3 1Academic Medical Center, 2Faculty of Economics and Business, University of Amsterdam, 3Atradius Credit Insurance, Amsterdam, The Netherlands Background: This paper analyzes how different types of Human immunodeficiency virus (HIV knowledge influences condom use across the sexes. Methods: The empirical work was based on a household survey conducted among 1979 households of a representative group of stallholders in Lagos, Nigeria in 2008. Condom use during last sexual intercourse was analyzed using a multivariate model corrected for clustering effects. The data included questions on socioeconomic characteristics, knowledge of the existence of HIV, HIV prevention, HIV stigma, intended pregnancy, and risk perceptions of engaging in unprotected sex. Results: A large HIV knowledge gap between males and females was observed. Across the sexes, different types of knowledge are important in condom use. Low-risk perceptions of engaging in unprotected sex and not knowing that condoms prevent HIV infection appear to be the best predictors for risky sexual behavior among men. For females, stigma leads to lower condom use. Obviously, lack of knowledge on where condoms are available (9.4% and 29.1% of male and female respondents, respectively reduced condom use in both males and females. Conclusion: The results call for programmatic approaches to differentiate between males and females in the focus of HIV prevention campaigns. Moreover, the high predictive power of high-risk perceptions of engaging in unprotected sex (while correcting for other HIV knowledge indicators calls for further exploration on how to influence these risk perceptions in HIV prevention programs. Keywords: Africa, condom, males, females, HIV/AIDS, knowledge, prevention, risk perception Using data from the 2004 National Survey of Adolescents in Uganda, logistic regression models were fitted to examine the odds that HIV/AIDS related knowledge and perceived risk of HIV infection are associated with condom use among adolescents. After including demographic measures, findings indicated that correct ... HIV knowledge and sexual risk behavior among street adolescents in rehabilitation centres in Kinshasa; DRC: gender differences. ... Background: Street children, common in Africa, are increasingly vulnerable to alcohol and drugs of abuse and lack access to both healthcare and knowledge about HIV and AIDS. Hence, this ... Armenta, Richard F; Abramovitz, Daniela; Lozada, Remedios; Vera, Alicia; Garfein, Richard S; Magis-Rodríguez, Carlos; Strathdee, Steffanie A We identified correlates of perceived risk of HIV infection among persons who inject drugs (PWID) in Tijuana. PWID ≥18 years of age who injected drugs in the past month were recruited between 2006-2007 and completed risk assessment interviews and serologic testing for HIV, syphilis, and tuberculosis. Logistic regression was used to determine factors associated with high-perceived risk of HIV infection. Among 974 PWID, HIV prevalence was 4.4%; 45.0% of participants perceived themselves to be more likely to become HIV infected relative to other PWID in Tijuana. Participants who reported high-perceived risk of HIV infection participated in high-risk behaviors such as injecting with used syringes, transactional sex, and were less likely to have had an HIV test. Recognition of HIV infection risk was associated with high risk behaviors and markers of vulnerability. Findings support efforts to encourage HIV testing and access to health care for this vulnerable population. Legarth, Rebecca; Omland, Lars H; Kronborg, Gitte .0 (95% CI 1.2-3.4) for population controls with low educational attainment compared with medium and high educational attainment. CONCLUSION: With free and equal access to healthcare, low educational attainment might increase risk of HIV infection among heterosexual individuals, but was not associated......OBJECTIVE: To estimate association between educational attainment and risk of HIV diagnosis, response to HAART, all-cause, and cause-specific mortality in Denmark in 1998-2009. DESIGN: Prospective, population-based cohort study including 1277 incident HIV-infected patients without hepatitis C virus...... or intravenous drug abuse identified in the Danish HIV Cohort Study and 5108 individually matched population controls. METHODS: Data on educational attainment, categorized as low, medium, or high, were identified in The Danish Attainment Register. Logistic and Poisson regression were used to estimate odds ratios... Kalichman, Seth C; Cherry, Chauncey; Kalichman, Moira O; Washington, Christopher; Grebler, Tamar; Merely, Cindy; Welles, Brandi; Pellowski, Jennifer; Kegler, Christopher Antiretroviral therapy (ART) improves the health of people living with HIV and has the potential to reduce HIV infectiousness, thereby preventing HIV transmission. However, the success of ART for HIV prevention hinges on sustained ART adherence and avoiding sexually transmitted infections (STI). To determine the sexual behaviours and HIV transmission risks of individuals with suppressed and unsuppressed HIV replication (i.e., viral load). Assessed HIV sexual transmission risks among individuals with clinically determined suppressed and unsuppressed HIV. Participants were 760 men and 280 women living with HIV in Atlanta, GA, USA, who completed behavioural assessments, 28-daily prospective sexual behaviour diaries, one-month prospective unannounced pill counts for ART adherence, urine screening for illicit drug use and medical record chart abstraction for HIV viral load. Individuals with unsuppressed HIV demonstrated a constellation of behavioural risks for transmitting HIV to uninfected sex partners that included symptoms of STI and substance use. In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma. Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners. Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART. Lama, T T; Sudhinaraset, M; McFarland, W; Raymond, H F In San Francisco, MSM account for nearly 90% of HIV infections. Studies have postulated increased risk for HIV faced by MSM who migrate, particularly to urban environments, yet empirical data are lacking. In this study we analyzed data from the National HIV Behavioral Surveillance System collected in 2011 to ascertain whether nativity (U.S. versus foreign born) was associated with HIV prevalence, risk behavior, and service use. Among 510 MSM enrolled, HIV prevalence was 23.0%. Multivariable analyses demonstrate that while nativity was not associated with increased risk for HIV infection, those who had lived in San Francisco for more than five years had higher HIV prevalence compared to those who had lived for less than a year even after adjusting for age, race, income, education, and location of birth. Müller-Rath, R; Mumme, T; Miltner, O; Skobel, E Bleeding facial injuries are not uncommon in competitive karate. Nevertheless, the risk of an infection with HIV is extremely low. Guidelines about the prevention of HIV infections are presented. Especially in contact sports and martial arts the athletes, judges and staff have to recognize and employ these recommendations. Bleeding wounds of the hands due to contact with the opponents teeth can be minimized by fist padding. Martinez-Donate, Ana P.; Blumberg, Elaine J.; Hovell, Melbourne F.; Sipan, Carol L.; Zellner, Jennifer A.; Hughes, Suzanne Previous studies have suggested high rates of HIV infection and other sexually transmitted infections in theU.S.-Mexico border region. However, no information is available on the risk for HIV infection among Mexican adolescents living in this geographic area. This study examines the prevalence of HIV risk practices and psychosocial correlates… Comfort, Megan; Reznick, Olga Grinstead; Dilworth, Samantha E; Binson, Diane; Darbes, Lynae A; Neilands, Torsten B The massively disproportionate impact of America's prison boom on communities of color has raised questions about how incarceration may affect health disparities, including disparities in HIV. Primary partners are an important source of influence on sexual health. In this paper, we investigate sexual HIV risk among male-female couples following a man's release from prison. We draw upon data from the Relate Project, a novel cross-sectional survey of recently released men and their female partners in Oakland and San Francisco, California (N=344). Inferential analyses use the actor-partner model to explore actor and partner effects on sexual HIV risk outcomes. Dyadic analyses of sexual HIV risk among male parolees and their female partners paint a complex portrait of couples affected by incarceration and of partners' influences on each other. Findings indicate that demographic factors such as education level and employment status, individual psycho-social factors such as perception of risk, and relationship factors such as commitment and power affect sexual HIV risk outcomes. The Relate Project provides a novel dataset for the dyadic analysis of sexual risk among male parolees and their female partners, and results highlight the importance of focusing on the couple as a unit when assessing HIV risk and protective behaviors. Results also indicate potentially fruitful avenues for population-specific interventions that may help to reduce sexual health disparities among couples affected by incarceration. Davis, Alissa; Jiwatram-Negrón, Tina; Primbetova, Sholpan; Terlikbayeva, Assel; Bilokon, Yelena; Chubukova, Lyubov; El-Bassel, Nabila Little is known about the prevalence and risk factors associated with sex trading among HIV-positive women. A total of 242 HIV-positive women were recruited in five regions in Kazakhstan. These women completed a survey containing items on socio-demographics, HIV stigma, intimate partner violence, and partner risk behaviors. Multivariate regression was used to examine associations between risk factors and sex trading after controlling for socio-demographic factors. Fifty-six (23.1%) women reported trading sex in the past 90 days. Women who reported recent sex trading were more likely than women who did not trade sex in the past 90 days to experience intimate partner violence (adjusted odds ratio [AOR]: 2.25; 95% confidence interval [CI]: 1.08-4.73), to have been homeless in the past 90 days (AOR: 4.12; 95% CI: 1.19-14.29), and to know or suspect a male partner had a sexually transmitted infection (AOR: 2.20; 95% CI: 1.07-4.53), had sex with another partner (AOR: 4.53; 95% CI: 2.25-9.14), or injected drugs in the past year (AOR: 3.31; 95% CI: 1.64-6.65). These findings underscore the need for comprehensive HIV prevention and intervention programs that address the multi-level risk factors associated with sex trading for women infected with HIV. Full Text Available The global fight against HIV is progressing; however, women living in rural areas particularly in sub-Saharan Africa (SSA continue to face the devastating consequences of HIV and AIDS. Lack of knowledge and geographical barriers to HIV services are compounded by gender norms often limiting the negotiation of safe sexual practices among women living in rural areas. This paper discusses findings from a qualitative study conducted in rural areas of Mozambique examining factors that influenced women to engage in HIV risk-reduction practices. The findings from this study led to the emergence of an HIV and AIDS risk assessment and reduction (HARAR model, which is described in detail. The model helps in understanding gender-related factors influencing men and women to engage in risk-reduction practices, which can be used as a framework in other settings to design more nuanced and contextual policies and programs. Full Text Available Abstract Background With ageing of the HIV-infected population, long-term exposure to treatment, varying adherence, emerging resistance and complications to therapies, effectiveness of Highly Active Antiretroviral Therapy (HAART needs to be monitored continuously at the population level. The German HIV-1 Seroconverter Cohort is a multi-centre, open, long-term observational cohort including patients with a known or reliably estimated date of HIV-infection i.e. last negative and first positive HIV antibody test within a maximum three-year interval or laboratory evidence of seroconversion. Our study aims to investigate survival improvements and changes in AIDS risk over calendar periods in the German HIV-1 Seroconverter Cohort. Methods Retrospective (for the pre-1997 period and prospective (since 1997 data from the German HIV-1 Seroconverter Cohort were used. Time from seroconversion to first AIDS-defining event over calendar periods was analysed by using Cox models adjusting for age at seroconversion, sex, transmission groups and short HIV test interval. Kaplan-Meier methods were used to determine expected survival (remaining AIDS-free by calendar period. Results 2162 seroconverters with 8976 person-years of observation were included in our analysis (up to 31.12.2010. A total of 196 first AIDSdefining events were reported. Two periods i.e. 19972000 and 2007-2010 were statistically associated with a reduction in the risk of AIDS, accounting for an overall reduction of 80%. Compared to1997-2000, hazard ratios were 2.6 (95%CI, 1.6-4.8; p=0.000 in pre-1997 and 0.5 (95%CI, 0.3-0.8; p=0.007 in 20072010. Independent risk factor for AIDS progression was age at seroconversion (HR, 1.3 per 10year-increase; p=0.001. Conclusion HAART effectiveness has improved in the German HIV-1-Seroconverter Cohort. The risk to develop AIDS decreased significantly in 19972000 and in 20072010. However, elderly may require particular monitoring in view of their faster Full Text Available Abstract Background Previous studies suggested a high prevalence of STDs including HIV among female sex workers and men who have sex with men in China, but little was known about the prevalence in male patients attending public STD clinics. The aim of this study was to investigate STD patterns and HIV prevalence among male STD clinic attendees in different areas in China and the associated risk factors. The feasibility of Provider-initiated HIV testing and counseling (PITC was evaluated as well. Methods A cross-sectional study was conducted at 46 public STD clinics in 4 provinces in China. Between July 2009 and September 2009, a total of 3243 eligible subjects were invited to participate in an interview with a structured-questionnaire for collecting socio-demographic characteristics and sexual behavioral information. They also were asked to provide venous blood samples for serological determinations of HIV and syphilis infection, and first void urine specimens for detecting Chlamydia trachomatis and Neisseria gonorrhoeae infections, Results Out of the 3243 eligible patients, 2951(91% men agreed to take part in the HIV and syphilis testing. The overall prevalence rate of HIV infection was 0.7% while the rates of syphilis, N. gonorrhoeae, C. trachomatis infections were 10.7%, 4.3% and 6.9%, respectively, with the highest syphilis and N. gonorrhoeae rates in Jiangsu Province. Patients from Guangxi province, homosexual/bisexual practices and intravenous drug use were significantly associated with HIV infection in multivariate logistic regression analyses. Provider-initiated HIV testing and counseling (PITC was well accepted by attendees, with 91% of eligible attendees agreeing to undergo HIV testing and counseling. All HIV positive patients were properly managed accordingly. Conclusions A modest prevalence of HIV infection and substantial prevalence of other STD infections were found among male patients attending public STD clinics in China. The Risk management in HIV/AIDS: ethical and economic issues associated with restricting HAART access only to adherent patients. ... Using the software TreeAge Pro 2009, we developed a Markov model to project economic outcomes for a hypothetical cohort of HIV/AIDS patients on HAART. The model compared two ... Bhatta, Dharma Nand Transgender women are a vulnerable and key risk group for HIV, and most research has shown an increased frequency of HIV infection among this minority population. This study examined the prevalence of HIV-related sexual risk behaviors and the socio-demographic correlates with HIV-related sexual risk behaviors among male-to-female (MtF) transgender persons. Data were collected from a sample of 232 individuals through venue-based and snowball sampling and face-to-face interviews. The HIV-related sexual risk behaviors among the MtF transgender persons were: sex without using a condom (48.3%; 95% confidence interval (CI) 41.8-54.8), unprotected anal sex (68.1%; 95% CI 62.0-74.2), and unprotected sex with multiple partners (88.4%; 95% CI 84.3-92.5). Statistically significant differences were found for age, income, education, alcohol habit, and sex with more than two partners per day for these three different HIV-related sexual risk behaviors. MtF transgender persons with a secondary or higher level of education were three times (OR 2.93) more likely to have unprotected sex with multiple partners compared to those with a primary level or no education. Age, education, income, frequency of daily sexual contact, and an alcohol habit remain significant with regard to HIV-related sexual risk behavior. There is an urgent need for programs and interventions to reduce risky sexual behaviors in this minority population. Copyright © 2014 The Author. Published by Elsevier Ltd.. All rights reserved. Colleen F Kelley Full Text Available Various metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL, population viral load (PVL, percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities.Using data from an ongoing HIV incidence cohort of black and white men who have sex with men (MSM, we propose a new metric to measure the prevalence of those at risk of transmitting HIV and illustrate its value. MSM with plasma VL>400 copies/mL were defined as having 'transmission risk'. We calculated HIV prevalence, CVL, PVL, percent of HIV-positive with undetectable viral loads, and prevalence of plasma VL>400 copies/ml (%VL400 for black and white MSM. We used Monte Carlo simulation incorporating data on sexual mixing by race to estimate exposure of black and white HIV-negative MSM to a partner with transmission risk via unprotected anal intercourse (UAI. Of 709 MSM recruited, 42% (168/399 black and 14% (44/310 white MSM tested HIV-positive (p<.0001. No significant differences were seen in CVL, PVL, or percent of HIV positive with undetectable viral loads. The %VL400 was 25% (98/393 for black vs. 8% (25/310 for white MSM (p<.0001. Black MSM with 2 UAI partners were estimated to have 40% probability (95% CI: 35%, 45% of having ≥1 UAI partner with transmission risk vs. 20% for white MSM (CI: 15%, 24%.Despite similarities in other metrics, black MSM in our cohort are three times as likely as white MSM to have HIV transmission risk. With comparable risk behaviors, HIV-negative black MSM have a substantially higher likelihood of encountering a UAI partner at risk of transmitting HIV. Our results support increasing HIV testing, linkage to care, and antiretroviral treatment of HIV-positive MSM to reduce prevalence of those with transmission risk, particularly for black MSM. Patrick William Woodburn Full Text Available Infections during pregnancy may have serious consequences for both mother and baby. Assessment of risk factors for infections informs planning of interventions and analysis of the impact of infections on health outcomes.To describe risk factors for helminths, malaria and HIV in pregnant Ugandan women before intervention in a trial of de-worming in pregnancy.The trial recruited 2,507 pregnant women between April 2003 and November 2005. Participants were interviewed and blood and stool samples obtained; location of residence at enrolment was mapped. Demographic, socioeconomic, behavioral and other risk factors were modelled using logistic regression.There was a high prevalence of helminth, malaria and HIV infection, as previously reported. All helminths and malaria parasitemia were more common in younger women, and education was protective against every infection. Place of birth and/or tribe affected all helminths in a pattern consistent with the geographical distribution of helminth infections in Uganda. Four different geohelminths (hookworm, Trichuris, Ascaris and Trichostrongylus showed a downwards trend in prevalence during the enrolment period. There was a negative association between hookworm and HIV, and between hookworm and low CD4 count among HIV-positive women. Locally, high prevalence of schistosomiasis and HIV occurred in lakeshore communities.Interventions for helminths, malaria and HIV need to target young women both in and out of school. Antenatal interventions for malaria and HIV infection must continue to be promoted. Women originating from a high risk area for a helminth infection remain at high risk after migration to a lower-risk area, and vice versa, but overall, geohelminths seem to be becoming less common in this population. High risk populations, such as fishing communities, require directed effort against schistosomiasis and HIV infection. Darak, Shrinivas; Gadgil, Mukta; Balestre, Eric; Kulkarni, Maitreyee; Kulkarni, Vinay; Kulkarni, Sanjeevani; Orne-Gliemann, Joanna Since the beginning of the HIV/AIDS epidemic in India, pregnant women attending antenatal clinics (ANC) have been considered as a low HIV risk population. Yet, a substantial proportion of new HIV infections are occurring among stable heterosexual couples. This paper sought to investigate the proportion and profile of women who, within the low-risk population, are potentially at higher risk of HIV infection. HIV risk perception of pregnant women enrolled within the ANRS 12127 Prenahtest trial was described and associated socio-behavioral characteristics, husband's characteristics, and HIV-related characteristics were analyzed using univariate and multivariate logistic regression models. Among 484 women enrolled, baseline data were collected for 479 women and 460 women with completed data were considered for the present analysis (96%). Eighty-nine (19.4%) women perceived themselves at risk of HIV. Women with educational level Women who had heard about sexually transmitted infections were also more likely to report HIV risk perception (AOR = 3.36 [CI = 1.83-6.18]). Substantial proportion of women (one out of five) perceived themselves at risk of HIV and most of these have reported some form of vulnerability in their couple relationship such as intimate partner violence, alcoholic partner, lack of communication, and spaces for communication with partner. Though awareness and knowledge is the first step for prevention, considering the vulnerabilities associated with HIV risk perception, HIV prevention interventions in India should target overall sources of vulnerability to HIV. Targeted risk reduction for women in ANC should be considered for primary HIV prevention among couples. Velloza, Jennifer; Watt, Melissa H; Abler, Laurie; Skinner, Donald; Kalichman, Seth C; Dennis, Alexis C; Sikkema, Kathleen J Alcohol use is associated with increased HIV-risk behaviors, including unprotected sex and number of sex partners. Alcohol-serving venues can be places to engage in HIV-related sexual risk behaviors, but are also important sites of social support for patrons, which may mitigate risks. We sought to examine the relationship between alcohol-serving venue attendance, social support, and HIV-related sexual risk behavior, by gender, in South Africa. Adult patrons (n = 496) were recruited from six alcohol-serving venues and completed surveys assessing frequency of venue attendance, venue-based social support, and recent sexual behaviors. Generalized estimating equations tested associations between daily venue attendance, social support, and sexual behaviors, separately by gender. Interaction effects between daily attendance and social support were assessed. Models were adjusted for venue, age, education, and ethnicity. Daily attendance at venues was similar across genders and was associated with HIV-related risk behaviors, but the strength and direction of associations differed by gender. Among women, daily attendance was associated with greater number of partners and higher proportion of unprotected sex. Social support was a significant moderator, with more support decreasing the strength of the relationship between attendance and risk. Among men, daily attendance was associated with a lower proportion of unprotected sex; no interaction effects were found for attendance and social support. Frequent venue attendance is associated with additional HIV-related risks for women, but this risk is mitigated by social support in venues. These results were not seen for men. Successful HIV interventions in alcohol-serving venues should address the gendered context of social support and sexual risk behavior. Mathur, Sanyukta; Higgins, Jenny A; Thummalachetty, Nityanjali; Rasmussen, Mariko; Kelley, Laura; Nakyanjo, Neema; Nalugoda, Fred; Santelli, John S Compared to a large body of work on how gender may affect young women's vulnerability to HIV, we know little about how masculine ideals and practices relating to marriage and fertility desires shape young men's HIV risk. Using life-history interview data with 30 HIV-positive and HIV-negative young men aged 15-24 years, this analysis offers an in-depth perspective on young men's transition through adolescence, the desire for fatherhood and experience of sexual partnerships in rural Uganda. Young men consistently reported the desire for fatherhood as a cornerstone of masculinity and transition to adulthood. Ideally young men wanted children within socially sanctioned unions. Yet, most young men were unable to realise their marital intentions. Gendered expectations to be economic providers combined with structural constraints, such as limited access to educational and income-generating opportunities, led some young men to engage in a variety of HIV-risk behaviours. Multiple partnerships and limited condom use were at times an attempt by some young men to attain some part of their aspirations related to fatherhood and marriage. Our findings suggest that young men possess relationship and parenthood aspirations that - in an environment of economic scarcity - may influence HIV-related risk. Full Text Available Abstract Background Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs in Indonesia, which has a rapidly growing HIV-epidemic largely driven by injecting drug use. Methods Current and former IDUs were recruited by respondent driven sampling in an urban setting in Java, and interviewed regarding drug use and HIV risk behavior using the European Addiction Severity Index and the Blood Borne Virus Transmission Questionnaire. Drug use and HIV transmission risk behavior were compared between current IDUs and former IDUs, using the Mann-Whitney and Pearson Chi-square test. Results Ninety-two out of 210 participants (44% were self reported former IDUs. Risk behavior related to sex, tattooing or piercing was common among current as well as former IDUs, 13% of former IDUs were still exposed to contaminated injecting equipment. HIV-infection was high among former (66% and current (60% IDUs. Conclusion Former IDUs may contribute significantly to the HIV-epidemic in Indonesia, and HIV-prevention should therefore also target this group, addressing sexual and other risk behavior. Dubé, Karine; Taylor, Jeff; Sylla, Laurie; Evans, David; Dee, Lynda; Burton, Alasdair; Willenberg, Loreen; Rennie, Stuart; Skinner, Asheley; Tucker, Joseph D; Weiner, Bryan J; Greene, Sandra B Biomedical research towards an HIV cure is advancing in the United States and elsewhere, yet little is known about perceptions of risks and benefits among potential study participants and other stakeholders. We conducted a qualitative study to explore perceived risks and benefits of investigational HIV cure research among people living with HIV (PLWHIV), biomedical HIV cure researchers, policy-makers and bioethicists. We conducted a qualitative research study using in-depth interviews with a purposive sample of PLWHIV, biomedical HIV cure researchers, policy-makers and bioethicists in 2015-2016. We analysed interview transcripts using thematic analysis anchored in grounded theory. We conducted and analyzed 36 key informant interviews. Qualitative analysis revealed four main findings. 1) Potential HIV cure study volunteers noted needing more information and education about the potential risks of HIV cure research. 2) Biomedical HIV cure researchers, policy-makers and bioethicists showed less awareness of social and financial risks of HIV cure research than PLWHIV. 3) Most respondents across the different categories of informants identified some risks that were too great to be acceptable in HIV cure research, although a subset of PLWHIV did not place an upper limit on acceptable risk. 4) PLWHIV showed a better awareness of potential psychological benefits of participating in HIV cure research than other groups of stakeholders. Our research suggests that PLWHIV have a variable understanding of the individual risks, sometimes substantial, associated with participating in biomedical HIV cure research studies. Community engagement and increased research literacy may help improve community understanding. Intensive informed consent procedures will be necessary for ethical study implementation. The current state of HIV cure research offers greater potential benefits to society than to participants. There is likely to be disagreement among regulators, researchers, clinicians Full Text Available Biomedical research towards an HIV cure is advancing in the United States and elsewhere, yet little is known about perceptions of risks and benefits among potential study participants and other stakeholders. We conducted a qualitative study to explore perceived risks and benefits of investigational HIV cure research among people living with HIV (PLWHIV, biomedical HIV cure researchers, policy-makers and bioethicists.We conducted a qualitative research study using in-depth interviews with a purposive sample of PLWHIV, biomedical HIV cure researchers, policy-makers and bioethicists in 2015-2016. We analysed interview transcripts using thematic analysis anchored in grounded theory.We conducted and analyzed 36 key informant interviews. Qualitative analysis revealed four main findings. 1 Potential HIV cure study volunteers noted needing more information and education about the potential risks of HIV cure research. 2 Biomedical HIV cure researchers, policy-makers and bioethicists showed less awareness of social and financial risks of HIV cure research than PLWHIV. 3 Most respondents across the different categories of informants identified some risks that were too great to be acceptable in HIV cure research, although a subset of PLWHIV did not place an upper limit on acceptable risk. 4 PLWHIV showed a better awareness of potential psychological benefits of participating in HIV cure research than other groups of stakeholders.Our research suggests that PLWHIV have a variable understanding of the individual risks, sometimes substantial, associated with participating in biomedical HIV cure research studies. Community engagement and increased research literacy may help improve community understanding. Intensive informed consent procedures will be necessary for ethical study implementation. The current state of HIV cure research offers greater potential benefits to society than to participants. There is likely to be disagreement among regulators, researchers Rothberg, Madeleine A.; Sandberg, Sonja; Awerbuch, Tamara E. The AIDS epidemic is still growing rapidly and the disease is thought to be uniformly fatal. With no vaccine or cure in sight, education during high school years is a critical component in the prevention of AIDS. We propose the use of computer software with which high school students can explore via simulation their own risk of acquiring an HIV infection given certain sexual behaviors. This particular software is intended to help students understand the three factors that determine their risk of HIV infection (number of sexual acts, probability that their partners are infected, and riskiness of the specific sexual activities they choose). Users can explicitly calculate their own chances of becoming infected based on decisions they make. Use of the program is expected to personalize the risk of HIV infection and thus increase users' concern and awareness. Behavioral change may not result from increased knowledge alone. Therefore the effectiveness of this program in changing attitudes toward risky sexual behaviors would be enhanced when the simulation is embedded in an appropriate curriculum. A description of the program and an example of its use are presented. Deiss, Robert G; Lozada, Remedios M; Burgos, Jose Luis; Strathdee, Steffanie A; Gallardo, Manuel; Cuevas, Jazmine; Garfein, Richard S Prior studies estimate HIV prevalence of 4% among injection drug users (IDUs), compared with 0.8% in the general population of Tijuana, Mexico. However, data on HIV prevalence and correlates among non-injecting drug users (NIDUs) are sparse. Individuals were recruited through street outreach for HIV testing and behavioural risk assessment interviews to estimate HIV prevalence and identify associated sexual risk behaviours among NIDUs in Tijuana. Descriptive statistics were used to characterise 'low-risk' NIDUs (drug users who were not commercial sex workers or men who have sex with men). Results showed that HIV prevalence was 3.7% among low-risk NIDUs. During the prior six months, 52% of NIDUs reported having >1 casual partner; 35% reported always using condoms with a casual partner; and 13% and 15%, respectively, reported giving or receiving something in exchange for sex. Women were significantly more likely than men to have unprotected sex with an IDU (pTijuana. Broad interventions including HIV testing, condom promotion and sexual risk reduction should be offered to all drug users in Tijuana. De Socio, Giuseppe V; Parruti, Giustino; Ricci, Elena; Maggi, Paolo; Celesia, Benedetto M; Penco, Giovanni; Martinelli, Canio; Franzetti, Marco; Di Biagio, Antonio; Bonfanti, Paolo; Pucci, Giacomo; Schillaci, Giuseppe Cardiovascular risk profile was compared in 765 Italian HIV-infected outpatients enrolled in 2005 and in 765 individually age-matched and sex-matched patients enrolled in 2011. Median Framingham risk score was 8.6% in 2005 vs. 7.9% in 2011 (P = 0.04); metabolic syndrome was present in 40.3% vs. 33.4% (P = 0.006). Blood glucose, triglycerides, prevalence of smokers, and lipodystrophy were all significantly lower in 2011 (all P < 0.0001). Cardiovascular risk improved over a 6-year period in Italian HIV-infected patients. Festinger, David S; Dugosh, Karen L; Metzger, David S; Marlowe, Douglas B A small percentage of participants in a large metropolitan felony Drug Court engaged in high-risk injection drug use, but a large percentage engaged in high-risk sexual behaviors. HIV risk behaviors were associated with being male, African-American, and younger. A large proportion of Drug Court participants resided in areas of the city with a high prevalence of persons living with HIV/AIDS, thus heightening the probability of exposure to the virus. Hirshfield, Sabina; Grov, Christian; Parsons, Jeffrey T; Anderson, Ian; Chiasson, Mary Ann Though Black and Hispanic men who have sex with men (MSM) are at an increased risk for HIV, few HIV risk reduction interventions that target HIV-positive MSM, and even fewer that use technology, have been designed to target these groups. Despite similar rates of social media and technology use across racial/ethnic groups, online engagement of minority MSM for HIV prevention efforts is low. Since minority MSM tend to have less representation in online HIV prevention studies, the goals of this online anonymous study of HIV-positive gay-identified men were to test the feasibility of conducting targeted recruitment by race/ethnicity and sexual orientation, to assess technology and social media use, and to assess global HIV transmission risk. In 2011, an anonymous online survey was conducted among 463 members of an HIV-positive personals website. Emails were sent to a subset of HIV-positive male members who self-identified as gay. While 57 % were White, substantial proportions of participants were Black (20 %) or Hispanic (18 %). Median age was 46 (range 18-79). Men who reported using 3 or more websites or apps to meet sex partners were significantly more likely to report anal intercourse (AOR 4.43, p social media use, and sexual risk among a diverse sample of HIV-positive gay men. Efficacy trials of technology-based HIV prevention interventions targeting high-risk minority HIV-positive MSM are warranted. Beaulaurier, Richard; Fortuna, Karen; Lind, Danielle; Emlet, Charles A Persons aged 50 years and over will soon disproportionately represent the future of the HIV/AIDS epidemic. It is estimated that by 2015 older adults will represent 50% of persons living with HIV in the United States. Despite the HIV/AIDS growing population among older adults, attitudes, beliefs, and stereotypes toward older adults that exist in general society have affected HIV prevention, education, and care. Specifically, ageist attitudes about the sexuality of older adults in general and older women in particular, low clinical HIV suspicion among healthcare providers, lack of knowledge about risk among older women, and differentials in power related to negotiating sexual practices all lead to heightened concerns for the prevention, identification, and treatment of HIV disease in mature women. This article examines common attitudes, beliefs, and stereotypes that exist within general society as well as health and social service providers that place older women at a disadvantage when it comes to HIV prevention, education, and treatment. Full Text Available Abstract Background Injection drug users represent the largest proportion of all HIV reported cases in Viet Nam. This study aimed to explore the perceptions of risk and risk behaviours among HIV-positive injection drug users, and their experiences related to safe injection and safe sex practices. Methods This study used multiple qualitative methods in data collection including in-depth interviews, focus group discussions and participant observation with HIV-positive injection drug users. Results The informants described a change in the sharing practices among injection drug users towards more precautions and what was considered 'low risk sharing', like sharing among seroconcordant partners and borrowing rather than lending. However risky practices like re-use of injection equipment and 'syringe pulling' i.e. the use of left-over drugs in particular, were frequently described and observed. Needle and syringe distribution programmes were in place but carrying needles and syringes and particularly drugs could result in being arrested and fined. Fear of rejection and of loss of intimacy made disclosure difficult and was perceived as a major obstacle for condom use among recently diagnosed HIV infected individuals. Conclusion HIV-positive injection drug users continue to practice HIV risk behaviours. The anti-drug law and the police crack-down policy appeared as critical factors hampering ongoing prevention efforts with needle and syringe distribution programmes in Viet Nam. Drastic policy measures are needed to reduce the very high HIV prevalence among injection drug users. Taarnhøj, Gry A.; Engsig, Frederik N; Ravn, Pernille Human Immunodeficiency Virus (HIV) infection predisposes to tuberculosis (TB). We described incidence, risk factors and prognosis of TB in HIV-1 infected patients during pre (1995-1996), early (1997-1999), and late Highly Active Antiretroviral Therapy (HAART) (2000-2007) periods.......Human Immunodeficiency Virus (HIV) infection predisposes to tuberculosis (TB). We described incidence, risk factors and prognosis of TB in HIV-1 infected patients during pre (1995-1996), early (1997-1999), and late Highly Active Antiretroviral Therapy (HAART) (2000-2007) periods.... Molatelo Elisa Shikwane Jan 3, 2014 ... To cite this article: Molatelo Elisa Shikwane, Olga M. Villar-Loubet, Stephen M. Weiss, Karl Peltzer & Deborah L. Jones. (2013) HIV knowledge, disclosure and sexual risk among pregnant women and their partners in rural South Africa, SAHARA-. J: Journal of Social Aspects of HIV/AIDS: An Open Access ... Gilbert, Louisa; Terlikbayeva, Assel; West, Brooke; Bearman, Peter; Wu, Elwin; Zhussupov, Baurzhan; Platais, Ingrida; Brisson, Anne Objectives. We examined the relationships between mobility characteristics and sexual risk behaviors among male and female migrant market vendors in Almaty, Kazakhstan. Methods. Participants completed a structured interview covering sociodemographics, mobility characteristics, sexual behaviors, and biomarkers for HIV, HCV, and syphilis. We used multivariate analyses to examine associations between mobility patterns and HIV risks after adjusting for sociodemographics. Results. Longer duration of a participant's last trip outside Almaty increased the odds of reporting multiple sexual partners. More frequent travel to visit family or friends was associated with multiple sexual partners and unprotected sex with steady partners. More frequent travel to buy goods in the past year was associated with multiple sexual partners. Men who traveled more often to buy goods were more likely to have purchased sex within the previous 90 days. Conclusions. Relationships between mobility patterns and sexual risk behaviors underscore the need for HIV-prevention strategies targeting the specific transmission dynamics that migrant vendors are likely to present. PMID:21493929 Amirkhanian, Yuri A Worldwide, men who have sex with men (MSM) remain one of the most HIV-vulnerable community populations. A global public health priority is developing new methods of reaching MSM, understanding HIV transmission patterns, and intervening to reduce their risk. Increased attention is being given to the role that MSM networks play in HIV epidemiology. This review of MSM network research studies demonstrates that: (1) Members of the same social network often share similar norms, attitudes, and HIV risk behavior levels; (2) Network interventions are feasible and powerful for reducing unprotected sex and potentially for increasing HIV testing uptake; (3) HIV vulnerability among African American MSM increases when an individual enters a high-risk sexual network characterized by high density and racial homogeneity; and (4) Networks are primary sources of social support for MSM, particularly for those living with HIV, with greater support predicting higher care uptake and adherence. Operario, Don; Kuo, Caroline C.; Sosa-Rubí, Sandra G.; Gálarraga, Omar Objective This paper reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. Methods We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories end behavioral economics can be combined into new approaches for HIV prevention. Results Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and STI prevalence, HIV testing, HIV medication adherence, and drug use. Conclusion CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PMID:24001243 Operario, Don; Kuo, Caroline; Sosa-Rubí, Sandra G; Gálarraga, Omar This article reviews psychology and behavioral economic approaches to HIV prevention, and examines the integration and application of these approaches in conditional economic incentive (CEI) programs for reducing HIV risk behavior. We discuss the history of HIV prevention approaches, highlighting the important insights and limitations of psychological theories. We provide an overview of the theoretical tenets of behavioral economics that are relevant to HIV prevention, and utilize CEIs as an illustrative example of how traditional psychological theories and behavioral economics can be combined into new approaches for HIV prevention. Behavioral economic interventions can complement psychological frameworks for reducing HIV risk by introducing unique theoretical understandings about the conditions under which risky decisions are amenable to intervention. Findings from illustrative CEI programs show mixed but generally promising effects of economic interventions on HIV and sexually transmitted infection (STI) prevalence, HIV testing, HIV medication adherence, and drug use. CEI programs can complement psychological interventions for HIV prevention and behavioral risk reduction. To maximize program effectiveness, CEI programs must be designed according to contextual and population-specific factors that may determine intervention applicability and success. PsycINFO Database Record (c) 2013 APA, all rights reserved. Koh, Kwee Choy; Yong, Lit Sin We describe the HIV risk perception, sexual behavior, and HIV prevalence among 423 men-who-have-sex-with-men (MSM) clients who received voluntary counseling and testing (VCT) services at a community-based center in Kuala Lumpur, Malaysia. The mean age was 29 years old. One hundred one (23.9%) clients rated themselves as low risk, 118 (27.9%) as medium risk, 36 (8.5%) as high risk, and 168 (39.7%) were unsure of their risk. Twenty-four (9.4%) clients tested HIV positive (4 (4%) low risk, 9 (7.6%) medium risk, 11 (30.6%) high risk, and 13 (7.7%) unsure risk). We found a positive correlation between risk perception and HIV infection in this study. Clients with high HIV risk perception have 17x the odds of testing HIV positive compared to low risk clients. High HIV risk perception was significantly associated with multiple sex partners, multiple types of sex partners, alcohol use before intercourse, unprotected sex beyond 6 months, and inconsistent condom use during anal sex compared to low risk clients. There were no statistically significant differences between medium risk and unsure risk clients compared to low risk clients. Strategies should be targeted towards change in sexual practices among those who are perceived to be at high risk. Grossman, A H Older gay men over the age of 50 have been and continue to be an invisible part of the HIV/AIDS epidemic. The reasons for this phenomenon are many, but among them are societal beliefs, myths, and stereotypes emanating from ageism and homophobia. In addition, HIV/AIDS is sometimes misdiagnosed in older adults because many of its symptoms mimic other illness that affect older people. Among the HIV risk factors of older gay men are internalized homophobia, denial of risk, alcohol and other substance use, and anonymous sexual encounters. The challenge for nurses and other providers is to reach, educate, and assist older gay men effectively in changing and maintaining safe behaviors when they are engaging in sexual and drug-using behaviors that can transmit HIV. Changes in Cardiovascular Disease Risk Factors With Immediate Versus Deferred Antiretroviral Therapy Initiation Among HIV-Positive Participants in the START (Strategic Timing of Antiretroviral Treatment) Trial Baker, Jason V; Sharma, Shweta; Achhra, Amit C INTRODUCTION: HIV infection and certain antiretroviral therapy (ART) medications increase atherosclerotic cardiovascular disease risk, mediated, in part, through traditional cardiovascular disease risk factors. METHODS AND RESULTS: We studied cardiovascular disease risk factor changes in the START...... (Strategic Timing of Antiretroviral Treatment) trial, a randomized study of immediate versus deferred ART initiation among HIV-positive persons with CD4+ cell counts >500 cells/mm3. Mean change from baseline in risk factors and the incidence of comorbid conditions were compared between groups....... The characteristics among 4685 HIV-positive START trial participants include a median age of 36 years, a CD4 cell count of 651 cells/mm3, an HIV viral load of 12 759 copies/mL, a current smoking status of 32%, a median systolic/diastolic blood pressure of 120/76 mm Hg, and median levels of total cholesterol of 168 mg... Cianelli, Rosina; Villegas, Natalia; Lawson, Sarah; Ferrer, Lilian; Kaelber, Lorena; Peragallo, Nilda; Yaya, Alexandra Hispanic women who are 50 years of age and older have been shown to be at increased risk of acquiring HIV infection due to age and culturally related issues. The purpose of our study was to investigate factors that increase HIV risk among older Hispanic women (OHW) as a basis for development or adaptation of an age and culturally tailored intervention designed to prevent HIV-related risk behaviors. We used a qualitative descriptive approach. Five focus groups were conducted in Miami, Florida, with 50 participants. Focus group discussions centered around eight major themes: intimate partner violence (IPV), perimenopausal-postmenopausal-related biological changes, cultural factors that interfere with HIV prevention, emotional and psychological changes, HIV knowledge, HIV risk perception, HIV risk behaviors, and HIV testing. Findings from our study stressed the importance of nurses' roles in educating OHW regarding IPV and HIV prevention. Copyright © 2013 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved. Rasmussen, Line D; Omland, Lars H; Pedersen, Court associated with the HIV disease and HAART or whether life-style related or genetic factors also increase the risk in this population. To establish whether the increased risk of myocardial infarction in HIV patients partly reflects an increased risk of MI in their families, we estimated the relative risk...... of MI in parents of HIV-infected individuals METHODS: From the Danish HIV Cohort Study and the Danish Civil Registration System we identified the parents of all HIV-infected patients born in Denmark after 1952 in whom a Danish born mother was identifiable. For each HIV patient, 4 matched population...... controls and their parents were identified. Cumulative incidence functions were constructed to illustrate time to first MI of the parents as registered in the Danish National Hospital Registry. Incidence rate ratios (IRR) were estimated by Cox's regression analyses. Due to the confidential type... The purpose of this study was to determine the effectiveness of BCC approach to the reduction of contracting HIV risk behavior in the construction laborers. Method: This study used operational research design. In this study measures the effectiveness of behavior change of construction workers on the prevention of HIV transmission by comparing the behavior of the construction workers before and after the intervention. The subjects of this study were 150 people risk group of construction workers who work and are spread throughout the city of Surabaya. This research was carried out into three phases, namely, phase preintervention research, intervention research, and post-intervention phase of the study. Implemented in the first year and second year praintervensi stage implemented intervention and post-intervention phases. Result: The results of this study showed that 72% of construction workers is productive (18–35 years and visit his family more than once a month (38%. There is 20% of construction workers had sex with commercial sex workers and no one was using drugs. By 50% of construction workers never get information about HIV/AIDS and as many as 48% never use the services of HIV/AIDS. Discussion: External motivation construction workers associated with the utilization of behavioral HIV/AIDS services with sufficient correlation. Strong external motivation is influenced by risk behaviors of HIV/AIDS were conducted and the desire to get help. Weak external motivation is influenced by a lack of exposure to information related to HIV/AIDS services. The results of the FGD stakeholders have the perception is the same if a construction worker is a high risk group of contracting HIV. Most of the construction workers not have enough knowledge for the prevention of HIV transmission because they do not have access to HIV care and behavior are at risk of contracting HIV by construction workers. Keywords: construction workers, behavior change communication, behavior de Munnik, S; den Daas, C; Ammerlaan, H S M; Kok, G; Raethke, M S; Vervoort, S C J M Despite prevention efforts, the incidence of sexually transmitted infection among HIV-positive men who have sex with men remains high, which is indicative of unchanged sexual risk behaviour. Discussing sexual risk behaviour has been shown to help prevent sexually transmitted infections among HIV-positive men who have sex with men. The aim of this study was to identify factors that influence whether - and how - specialised HIV nurses discuss sexual risk behaviour with HIV-positive men who have sex with men. Identifying these factors could indicate how best to improve the frequency and quality of discussions about sexual risk behaviour, thereby reducing sexual risk behaviour and sexually transmitted infections. Qualitative study, focus groups among HIV nurses. Dutch HIV treatment centres. A purposive sample was taken of 25 out of 87 HIV nurses working in one of the 26 specialised HIV treatment centres in the Netherlands. Of the 25 HIV nurses we approached, 22 participate in our study. Three semi-structured focus group interviews were held with 22 HIV nurses from 17 hospitals. Interviews were transcribed verbatim, and thematic analysis was performed. HIV nurses agreed that discussing sexual risk behaviour is important, but barriers were experienced in relation to doing so. In accordance with the theory of planned behaviour, attitudes, perceived norms and perceived behavioural control were all found to be relevant variables. Barriers to discussing sexual risk behaviour were identified as: dealing with embarrassment, the changing professional role of an HIV nurse, time constraints, and the structure of the consultation. To improve the frequency and quality of discussions about sexual risk behaviour with HIV-positive men who have sex with men, our data suggests it would be beneficial to support HIV nurses by developing tools and guidelines addressing what to discuss and how. Using a related topic as a conversational 'bridge' may help nurses to broach this subject with Camlin, Carol S; Kwena, Zachary A; Dworkin, Shari L; Cohen, Craig R; Bukusi, Elizabeth A Migration and HIV research in sub-Saharan Africa has focused on HIV risks to male migrants, yet women's levels of participation in internal migration have met or exceeded those of men in the region. Moreover, studies that have examined HIV risks to female migrants found higher risk behavior and HIV prevalence among migrant compared to non-migrant women. However, little is known about the pathways through which participation in migration leads to higher risk behavior in women. This study aimed to characterize the contexts and processes that may facilitate HIV acquisition and transmission among migrant women in the Kisumu area of Nyanza Province, Kenya. We used qualitative methods, including 6 months of participant observation in women's common migration destinations and in-depth semi-structured interviews conducted with 15 male and 40 female migrants selected from these destinations. Gendered aspects of the migration process may be linked to the high risks of HIV observed in female migrants - in the circumstances that trigger migration, livelihood strategies available to female migrants, and social features of migration destinations. Migrations were often precipitated by household shocks due to changes in marital status (as when widowhood resulted in disinheritance) and gender-based violence. Many migrants engaged in transactional sex, of varying regularity, from clandestine to overt, to supplement earnings from informal sector trading. Migrant women are at high risk of HIV transmission and acquisition: the circumstances that drove migration may have also increased HIV infection risk at origin; and social contexts in destinations facilitate having multiple sexual partners and engaging in transactional sex. We propose a model for understanding the pathways through which migration contributes to HIV risks in women in high HIV prevalence areas in Africa, highlighting potential opportunities for primary and secondary HIV prevention at origins and destinations, and at Rotger, Margalida; Glass, Tracy R.; Junier, Thomas; Lundgren, Jens; Neaton, James D.; Poloni, Estella S.; van 't Wout, Angélique B.; Lubomirov, Rubin; Colombo, Sara; Martinez, Raquel; Rauch, Andri; Günthard, Huldrych F.; Neuhaus, Jacqueline; Wentworth, Deborah; van Manen, Danielle; Gras, Luuk A.; Schuitemaker, Hanneke; Albini, Laura; Torti, Carlo; Jacobson, Lisa P.; Li, Xiuhong; Kingsley, Lawrence A.; Carli, Federica; Guaraldi, Giovanni; Ford, Emily S.; Sereti, Irini; Hadigan, Colleen; Martinez, Esteban; Arnedo, Mireia; Egaña-Gorroño, Lander; Gatell, Jose M.; Law, Matthew; Bendall, Courtney; Petoumenos, Kathy; Rockstroh, Jürgen; Wasmuth, Jan-Christian; Kabamba, Kabeya; Delforge, Marc; de Wit, Stephane; Berger, Florian; Mauss, Stefan; de Paz Sierra, Mariana; Losso, Marcelo; Belloso, Waldo H.; Leyes, Maria; Campins, Antoni; Mondi, Annalisa; de Luca, Andrea; Bernardino, Ignacio; Barriuso-Iglesias, Mónica; Torrecilla-Rodriguez, Ana; Gonzalez-Garcia, Juan; Arribas, José R.; Fanti, Iuri; Gel, Silvia; Puig, Jordi; Negredo, Eugenia; Gutierrez, Mar; Domingo, Pere; Fischer, Julia; Fätkenheuer, Gerd; Alonso-Villaverde, Carlos; Macken, Alan; Woo, James; McGinty, Tara; Mallon, Patrick; Mangili, Alexandra; Skinner, Sally; Wanke, Christine A.; Reiss, Peter; Weber, Rainer; Bucher, Heiner C.; Fellay, Jacques; Telenti, Amalio; Tarr, Philip E.; Gras, A. Luuk; van Wout, Angelique B.; Arnedo-Valero, Mireia; Sierra, Mariana de Paz; Rodriguez, Ana Torrecilla; Garcia, Juan Gonzalez; Arribas, Jose R.; Aubert, V.; Barth, J.; Battegay, M.; Bernasconi, E.; Böni, J.; Bucher, H. C.; Burton-Jeangros, C.; Calmy, A.; Cavassini, M.; Egger, M.; Elzi, L.; Fehr, J.; Fellay, J.; Francioli, P.; Furrer, H.; Fux, C. A.; Gorgievski, M.; Günthard, H.; Haerry, D.; Hasse, B.; Hirsch, H. H.; Hirschel, B.; Hösli, I.; Kahlert, C.; Kaiser, L.; Keiser, O.; Kind, C.; Klimkait, T.; Kovari, H.; Ledergerber, B.; Martinetti, G.; Martinez de Tejada, B.; Metzner, K.; Müller, N.; Nadal, D.; Pantaleo, G.; Rauch, A.; Regenass, S.; Rickenbach, M.; Rudin, C.; Schmid, P.; Schultze, D.; Schöni-Affolter, F.; Schüpbach, J.; Speck, R.; Taffé, P.; Tarr, P.; Telenti, A.; Trkola, A.; Vernazza, P.; Weber, R.; Prins, Yerly S. J. M.; Kuijpers, T. W.; Scherpbier, H. J.; Boer, K.; van der Meer, J. T. M.; Wit, F. W. M. N.; Godfried, M. H.; van der Poll, T.; Nellen, F. J. B.; Lange, J. M. A.; Geerlings, S. E.; van Vugt, M.; Vrouenraets, S. M. E.; Pajkrt, D.; Bos, J. C.; van der Valk, M.; Schreij, G.; Lowe, S.; Oude Lashof, A.; Pronk, M. J. H.; Bravenboer, B.; van der Ende, M. E.; de Vries-Sluijs, T. E. M. S.; Schurink, C. A. M.; van der Feltz, M.; Nouwen, J. L.; Gelinck, L. B. S.; Verbon, A.; Rijnders, B. J. A.; van de Ven-de Ruiter, E. D.; Slobbe, L.; Haag, Den; Kauffmann, R. H.; Schippers, E. F.; Groeneveld, P. H. P.; Alleman, M. A.; Bouwhuis, J. W.; ten Kate, R. W.; Soetekouw, R.; Kroon, F. P.; van den Broek, P. J.; van Dissel, J. T.; Arend, S. M.; van Nieuwkoop, C.; de Boer, M. J. G.; Jolink, H.; den Hollander, J. G.; Pogany, K.; Bronsveld, W.; Kortmann, W.; van Twillert, G.; van Houte, D. P. F.; Polée, M. B.; van Vonderen, M. G. A.; ten Napel, C. H. H.; Kootstra, G. J.; Brinkman, K.; Blok, W. L.; Frissen, P. H. J.; Schouten, W. E. M.; van den Berk, G. E. L.; Juttmann, J. R.; van Kasteren, M. E. E.; Brouwer, A. E.; Mulder, J. W.; van Gorp, E. C. M.; Smit, P. M.; Weijer, S.; van Eeden, A.; Verhagen, D. W. M.; Sprenger, H. G.; Doedens, R.; Scholvinck, E. H.; van Assen, S.; Stek, C. J.; Hoepelman, I. M.; Mudrikova, T.; Schneider, M. M. E.; Jaspers, C. A. J. J.; Ellerbroek, P. M.; Peters, E. J. G.; Maarschalk-Ellerbroek, L. J.; Oosterheert, J. J.; Arends, J. E.; Wassenberg, M. W. M.; van der Hilst, J. C. H.; Richter, C.; van der Berg, J. P.; Gisolf, E. H.; Margolick, Joseph B.; Plankey, Michael; Crain, Barbara; Dobs, Adrian; Farzadegan, Homayoon; Gallant, Joel; Johnson-Hill, Lisette; Sacktor, Ned; Selnes, Ola; Shepard, James; Thio, Chloe; Phair, John P.; Wolinsky, Steven M.; Badri, Sheila; Conover, Craig; O'Gorman, Maurice; Ostrow, David; Palella, Frank; Ragin, Ann; Detels, Roger; Martínez-Maza, Otoniel; Aronow, Aaron; Bolan, Robert; Breen, Elizabeth; Butch, Anthony; Fahey, John; Jamieson, Beth; Miller, Eric N.; Oishi, John; Vinters, Harry; Visscher, Barbara R.; Wiley, Dorothy; Witt, Mallory; Yang, Otto; Young, Stephen; Zhang, Zuo Feng; Rinaldo, Charles R.; Becker, James T.; Cranston, Ross D.; Martinson, Jeremy J.; Mellors, John W.; Silvestre, Anthony J.; Stall, Ronald D.; Muñoz, Alvaro; Abraham, Alison; Althoff, Keri; Cox, Christopher; D'Souza, Gypsyamber; Gange, Stephen J.; Golub, Elizabeth; Schollenberger, Janet; Seaberg, Eric C.; Su, Sol; Huebner, Robin E.; Dominguez, Geraldina; Moroni, M.; Angarano, G.; Antinori, A.; Carosi, G.; Cauda, R.; Monforte, A. d'Arminio; Di Perri, G.; Galli, M.; Iardino, R.; Ippolito, G.; Lazzarin, A.; Perno, C. F.; Sagnelli, E.; Viale, P. L.; Von Schlosser, F.; d'Arminio Monforte, A.; Ammassari, A.; Andreoni, M.; Balotta, C.; Bonfanti, P.; Bonora, S.; Borderi, M.; Capobianchi, M. R.; Castagna, A.; Ceccherini-Silberstein, F.; Cozzi-Lepri, A.; de Luca, A.; Gargiulo, M.; Gervasoni, C.; Girardi, E.; Lichtner, M.; Lo Caputo, S.; Madeddu, G.; Maggiolo, F.; Marcotullio, S.; Monno, L.; Murri, R.; Mussini, C.; Puoti, M.; Torti, C.; Fanti, I.; Formenti, T.; Galli, Laura; Lorenzini, Patrizia; Montroni, M.; Giacometti, A.; Costantini, A.; Riva, A.; Tirelli, U.; Martellotta, F.; Ladisa, N.; Lazzari, G.; Verucchi, G.; Castelli, F.; Scalzini, A.; Minardi, C.; Bertelli, D.; Quirino, T.; Abeli, C.; Manconi, P. E.; Piano, P.; Vecchiet, J.; Falasca, K.; Carnevale, G.; Lorenzotti, S.; Sighinolfi, L.; Segala, D.; Leoncini, F.; Mazzotta, F.; Pozzi, M.; Cassola, G.; Viscoli, G.; Viscoli, A.; Piscopo, R.; Mazzarello, G.; Mastroianni, C.; Belvisi, V.; Caramma, I.; Chiodera, A.; Castelli, P.; Rizzardini, G.; Ridolfo, A. L.; Foschi, A.; Salpietro, S.; Galli, A.; Bigoloni, A.; Spagnuolo, V.; Merli, S.; Carenzi, L.; Moioli, M. C.; Cicconi, P.; Bisio, L.; Gori, A.; Lapadula, G.; Abrescia, N.; Chirianni, A.; de Marco, M.; Ferrari, C.; Borghi, R.; Baldelli, F.; Belfiori, B.; Parruti, G.; Ursini, T.; Magnani, G.; Ursitti, M. A.; Narciso, P.; Tozzi, V.; Vullo, V.; d'Avino, A.; Zaccarelli, M.; Gallo, L.; Acinapura, R.; Capozzi, M.; Libertone, R.; Trotta, M. P.; Tebano, G.; Cattelan, A. M.; Mura, M. S.; Caramello, P.; Orofino, G. C.; Sciandra, M.; Raise, N. N.; Ebo, F.; Pellizzer, G.; Manfrin, V.; Law, M.; Petoumenos, K.; McManus, H.; Wright, S.; Bendall, C.; Moore, R.; Edwards, S. Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the setting of HIV Full Text Available It is commonly assumed that sexual risk factors for heterosexual HIV transmission in sub-Saharan Africa, such as multi-partner sex, paid sex and co-infections, become less important as HIV epidemics mature and prevalence increases.We conducted a systematic review of 68 African epidemiological studies from 1986 to 2006 involving 17,000 HIV positive adults and 73,000 controls. We used random-effects methods and stratified results by gender, time, background HIV prevalence rates and other variables. The number of sex partners, history of paid sex, and infection with herpes simplex virus (HSV-2 or other sexually-transmitted infections (STIs each showed significant associations with HIV infection. Among the general population, the odds ratio (OR of HIV infection for women reporting 3+ sex partners versus 0-2 was 3.64 (95%CI [2.87-4.62], with similar risks for men. About 9% of infected women reported ever having been paid for sex, versus 4% of control women (OR = 2.29, [1.45-3.62]. About 31% of infected men reported ever paying for sex versus 18% of uninfected men (OR = 1.75, [1.30-2.36]. HSV-2 infection carried the largest risk of HIV infection: OR = 4.62, [2.85-7.47] in women, and OR = 6.97, [4.68-10.38] in men. These risks changed little over time and stratification by lower and higher HIV background prevalence showed that risk ratios for most variables were larger in high prevalence settings. Among uninfected controls, the male-female differences in the number of sex partners and in paid sex were more extreme in the higher HIV prevalence settings than in the lower prevalence settings.Multi-partner sex, paid sex, STIs and HSV-2 infection are as important to HIV transmission in advanced as in early HIV epidemics. Even in high prevalence settings, prevention among people with high rates of partner change, such as female sex workers and their male clients, is likely to reduce transmission overall. A major component of HIV prevention is to encourage individuals to appreciate their personal risk of contracting the virus with the aim of encouraging them to take steps to reduce the risks. This article addresses the accuracy of an individual's risk assessment by matching this with individual's reported risk behaviours in order ... Sawitri, Anak Agung Sagung; Hartawan, Anak Agung Gede; Craine, Noel; Sari, Ayu Kartika; Septarini, Ni Wayan; Wirawan, Dewa Nyoman The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia. A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix. Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8 percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV. The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics. The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting. This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program. Harboe, Zitta Barrella; Larsen, Mette; Ladelund, Steen with an increased risk of IPD. Detectable viral loads (RR, 1.88 [95% CI, 1.79-1.98]) and a relative fall in CD4 T-cell counts were also associated with an increased risk (≥500 to 350-500 CD4 T cells/µL: RR, 1.29 [95% CI, 1.21-1.37] and risk of IPD declined over time......BACKGROUND: Invasive pneumococcal disease (IPD) is an important cause of morbidity among individuals infected with human immunodeficiency virus (HIV). We described incidence and risk factors for IPD in HIV-infected and uninfected individuals. METHODS: Nationwide population-based cohort study of HIV......-infected adults treated at all Danish HIV treatment centers during 1995-2012. Nineteen population-matched controls per HIV-infected individual were retrieved. The risk of IPD was assessed using Poisson regression. RESULTS: The incidence of IPD was 304.7 cases per 100 000 person-years of follow-up (PYFU) in HIV... Myer, L; Phillips, T K; McIntyre, J A; Hsiao, N-Y; Petro, G; Zerbe, A; Ramjith, J; Bekker, L-G; Abrams, E J Maternal HIV viral load (VL) drives mother-to-child HIV transmission (MTCT) risk but there are few data from sub-Saharan Africa, where most MTCT occurs. We investigated VL changes during pregnancy and MTCT following antiretroviral therapy (ART) initiation in Cape Town, South Africa. We conducted a prospective study of HIV-infected women initiating ART within routine antenatal services in a primary care setting. VL measurements were taken before ART initiation and up to three more times within 7 days postpartum. Analyses examined VL changes over time, viral suppression (VS) at delivery, and early MTCT based on polymerase chain reaction (PCR) testing up to 8 weeks of age. A total of 620 ART-eligible HIV-infected pregnant women initiated ART, with 2425 VL measurements by delivery (median gestation at initiation, 20 weeks; median pre-ART VL, 4.0 log 10 HIV-1 RNA copies/mL; median time on ART before delivery, 118 days). At delivery, 91% and 73% of women had VL ≤ 1000 and ≤ 50 copies/mL, respectively. VS was strongly predicted by time on therapy and pre-ART VL. The risk of early MTCT was strongly associated with delivery VL, with risks of 0.25, 2.0 and 8.5% among women with VL 1000 copies/mL at delivery, respectively (P pregnancy and with high VL appear substantially less likely to achieve VS and require targeted research and programmatic attention. © 2016 British HIV Association. Tully, Stephen; Cojocaru, Monica; Bauch, Chris T. There has been growing use of highly active antiretroviral treatment (HAART) for HIV and significant progress in developing prophylactic HIV vaccines. The simplest theories of counterproductive behavioral responses to such interventions tend to focus on single feedback mechanisms: for instance, HAART optimism makes infection less scary and thus promotes risky sexual behavior. Here, we develop an agent based, age-structured model of HIV transmission, risk perception, and partner selection in a core group to explore behavioral responses to interventions. We find that interventions can activate not one, but several feedback mechanisms that could potentially influence decision-making and HIV prevalence. In the model, HAART increases the attractiveness of unprotected sex, but it also increases perceived risk of infection and, on longer timescales, causes demographic impacts that partially counteract HAART optimism. Both HAART and vaccination usually lead to lower rates of unprotected sex on the whole, but intervention effectiveness depends strongly on whether individuals over- or under-estimate intervention coverage. Age-specific effects cause sexual behavior and HIV prevalence to change in opposite ways in old and young age groups. For complex infections like HIV—where interventions influence transmission, demography, sexual behavior and risk perception—we conclude that evaluations of behavioral responses should consider multiple feedback mechanisms. PMID:26507957 reproductive and sexual health characteristics of the participants, knowledge on HIV ... Keywords: HIV, older adults, prevalence, knowledge, risk factors, Tanzania ... With increased availability of ART, people are living longer and age with HIV ... Simnikiwe H Mayaphi Full Text Available To assess the prevalence of HIV risk behaviour among sexually active HIV sero-negative individuals in the Tshwane district of South Africa (SA.Demographic and HIV risk behaviour data were collected on a questionnaire from participants of a cross-sectional study that screened for early HIV infection using pooled nucleic acid amplification testing (NAAT. The study enrolled individuals who tested negative on rapid HIV tests performed at five HIV counseling and testing (HCT clinics, which included four antenatal clinics and one general HCT clinic.The study enrolled 9547 predominantly black participants (96.6% with a median age of 27 years (interquartile range [IQR]: 23-31. There were 1661 non-pregnant and 7886 pregnant participants largely enrolled from the general and antenatal HCT clinics, respectively. NAAT detected HIV infection in 61 participants (0.6%; 95% confidence interval [CI]: 0.4-0.8 in the whole study. A high proportion of study participants, 62.8% and 63.0%, were unaware of their partner's HIV status; and also had high prevalence, 88.5% and 99.5%, of recent unprotected sex in the general and pregnant population, respectively. Consistent use of condoms was associated with protection against HIV infection in the general population. Trends of higher odds for HIV infection were observed with most demographic and HIV risk factors at univariate analysis, however, multivariate analysis did not show statistical significance for almost all these factors. A significantly lower risk of HIV infection was observed in circumcised men (p <0.001.These data show that a large segment of sexually active people in the Tshwane district of SA have high risk exposure to HIV. The detection of newly diagnosed HIV infections in all study clinics reflects a wide distribution of individuals who are capable of sustaining HIV transmission in the setting where HIV risk behaviour is highly prevalent. A questionnaire that captures HIV risk behaviour would be useful Gerbi, Gemechu B; Habtemariam, Tsegaye; Tameru, Berhanu; Nganwa, David; Robnett, Vinaida The objective of this study is to conduct a quantitative risk assessment of multiple factors influencing HIV/AIDS transmission through unprotected sexual practices among HIV-seropositive men. A knowledgebase was developed by reviewing different published sources. The data were collected from different sources including Centers for Disease Control and Prevention, selected journals, and reports. The risk pathway scenario tree was developed based on a comprehensive review of published literature. The variables are organized into nine major parameter categories. Monte Carlo simulations for the quantitative risk assessment of HIV/AIDS transmission was executed with the software @Risk 4.0 (Palisade Corporation). Results show that the value for the likelihood of unprotected sex due to having less knowledge about HIV/AIDS and negative attitude toward condom use and safer sex ranged from 1.24 × 10(-5) to 8.47 × 10(-4) with the mean and standard deviation of 1.83 × 10(-4) and 8.63 × 10(-5), respectively. The likelihood of unprotected sex due to having greater anger-hostility, anxiety, less satisfied with aspects of life, and greater depressive symptoms ranged from 2.76 × 10(-9) to 5.34 × 10(-7) with the mean and standard deviation of 5.23 × 10(-8) and 3.58 × 10(-8), respectively. The findings suggest that HIV/AIDS research and intervention programs must be focused on behavior, and the broader setting within which individual risky behaviors occur. Engsig, F N; Omland, Lars Haukali Hvass; Larsen, M V According to the Swiss Federal Commission for HIV/AIDS, HIV-infected patients on successful antiretroviral treatment have a negligible risk of transmitting HIV sexually. We estimated the risk that patients considered to have an undetectable viral load (VL) are actually viraemic.......According to the Swiss Federal Commission for HIV/AIDS, HIV-infected patients on successful antiretroviral treatment have a negligible risk of transmitting HIV sexually. We estimated the risk that patients considered to have an undetectable viral load (VL) are actually viraemic.... Stewart, Angela J.; Theodore-Oklota, Christina; Hadley, Wendy; Brown, Larry K.; Donenberg, Geri; DiClemente, Ralph This study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, "M" age = 14.9 years) who received mental… Kwee Choy Koh Full Text Available We describe the HIV risk perception, sexual behavior, and HIV prevalence among 423 men-who-have-sex-with-men (MSM clients who received voluntary counseling and testing (VCT services at a community-based center in Kuala Lumpur, Malaysia. The mean age was 29 years old. One hundred one (23.9% clients rated themselves as low risk, 118 (27.9% as medium risk, 36 (8.5% as high risk, and 168 (39.7% were unsure of their risk. Twenty-four (9.4% clients tested HIV positive (4 (4% low risk, 9 (7.6% medium risk, 11 (30.6% high risk, and 13 (7.7% unsure risk. We found a positive correlation between risk perception and HIV infection in this study. Clients with high HIV risk perception have 17x the odds of testing HIV positive compared to low risk clients. High HIV risk perception was significantly associated with multiple sex partners, multiple types of sex partners, alcohol use before intercourse, unprotected sex beyond 6 months, and inconsistent condom use during anal sex compared to low risk clients. There were no statistically significant differences between medium risk and unsure risk clients compared to low risk clients. Strategies should be targeted towards change in sexual practices among those who are perceived to be at high risk. Camlin, Carol S.; Kwena, Zachary A.; Dworkin, Shari L.; Cohen, Craig R.; Bukusi, Elizabeth A. Migration and HIV research in sub-Saharan Africa has focused on HIV risks to male migrants, yet women’s levels of participation in internal migration have met or exceeded those of men in the region. Moreover, studies that have examined HIV risks to female migrants found higher risk behavior and HIV prevalence among migrant compared to non-migrant women. However, little is known about the pathways through which participation in migration leads to higher risk behavior in women. This study aimed to characterize the contexts and processes that may facilitate HIV acquisition and transmission among migrant women in the Kisumu area of Nyanza Province, Kenya. We used qualitative methods, including 6 months of participant observation in women’s common migration destinations and in-depth semi-structured interviews conducted with 15 male and 40 female migrants selected from these destinations. Gendered aspects of the migration process may be linked to the high risks of HIV observed in female migrants— in the circumstances that trigger migration, livelihood strategies available to female migrants, and social features of migration destinations. Migrations were often precipitated by household shocks due to changes in marital status (as when widowhood resulted in disinheritance) and gender-based violence. Many migrants engaged in transactional sex, of varying regularity, from clandestine to overt, to supplement earnings from informal sector trading. Migrant women are at high risk of HIV transmission and acquisition: the circumstances that drove migration may have also increased HIV infection risk at origin; and social contexts in destinations facilitate having multiple sexual partners and engaging in transactional sex. We propose a model for understanding the pathways through which migration contributes to HIV risks in women in high HIV prevalence areas in Africa, highlighting potential opportunities for primary and secondary HIV prevention at origins and destinations, and Velasquez, Michele G; Laniado-Laborin, Rafael; Rodwell, Timothy C; Cerecer, Paris; Lozada, Remedios; Cuevas-Mota, Jazmine; Burgos, Jose Luis; Garfein, Richard S To assess the prevalence of prior tuberculin skin testing (TST) among populations at risk for HIV infection in Tijuana, Mexico, and to identify factors associated with TST. Sex workers, injection drug users, noninjecting drug users, and homeless persons > 18 years old were recruited by using targeted sampling for risk assessment interviews and serologic testing for HIV and Mycobacterium tuberculosis infection. Univariate and multivariate logistic regression were used to identify correlates of self-reported TST history. Of 502 participants, 38.0% reported prior TST, which was associated with previous incarceration in the United States of America [odds ratio (OR) = 13.38; 95% confidence interval (CI) = 7.37-24.33] and injection drug use (OR = 1.99; 95% CI = 1.27- 3.11). Positive results on serologic tests for M. tuberculosis infection (57%) and HIV (4.2%) were not associated with a prior TST. A history of TST was lower in HIV-positive participants even though TST is indicated for persons with HIV in Mexico. Fewer than half the individuals at high risk for HIV in this study had a history of TST; however, TST was fairly common among those individuals with a prior history of incarceration. Increased tuberculosis screening is needed for populations at risk of contracting HIV in Tijuana, particularly those outside of criminal justice settings. Rosenberg, Molly S; Seavey, Brian K; Jules, Reginal; Kershaw, Trace S Microfinance loans targeted at vulnerable female populations have the potential to foster female economic independence, possibly leading to the negotiation of safer sexual practices and reduced HIV risk. This study assessed the relationship between experience with microfinance loans and HIV risk behavior among 192 female clients of the Haitian microfinance organization Fonkoze. Clients with longer microfinance experience were generally found to have lower indicators of HIV risk behavior and higher indicators of relationship power compared to those with shorter experience. In particular, those with longer memberships were 72% less likely to report partner infidelity, were 3.95 times more likely to use condoms with an unfaithful partner, and had higher average general power index scores compared to those with shorter experience. This study provides evidence that long-term exposure to microfinance is associated with reduced HIV risk behavior in Haitian women and that this reduction may be partly regulated by influencing relationship power. These results suggest the need to further explore the use of microfinance as a tool to prevent the spread of HIV. Kirk, Gregory D; Merlo, Christian; O' Driscoll, Peter; Mehta, Shruti H; Galai, Noya; Vlahov, David; Samet, Jonathan; Engels, Eric A Human immunodeficiency virus (HIV)-infected persons have an elevated risk for lung cancer, but whether the increase reflects solely their heavy tobacco use remains an open question. The Acquired Immunodeficiency Syndrome (AIDS) Link to the Intravenous Experience Study has prospectively observed a cohort of injection drug users in Baltimore, Maryland, since 1988, using biannual collection of clinical, laboratory, and behavioral data. Lung cancer deaths were identified through linkage with the National Death Index. Cox proportional hazards regression was used to examine the effect of HIV infection on lung cancer risk, controlling for smoking status, drug use, and clinical variables. Among 2086 AIDS Link to the Intravenous Experience Study participants observed for 19,835 person-years, 27 lung cancer deaths were identified; 14 of the deaths were among HIV-infected persons. All but 1 (96%) of the patients with lung cancer were smokers, smoking a mean of 1.2 packs per day. Lung cancer mortality increased during the highly active antiretroviral therapy era, compared with the pre-highly active antiretroviral therapy period (mortality rate ratio, 4.7; 95% confidence interval, 1.7-16). After adjusting for age, sex, smoking status, and calendar period, HIV infection was associated with increased lung cancer risk (hazard ratio, 3.6; 95% confidence interval, 1.6-7.9). Preexisting lung disease, particularly noninfectious diseases and asthma, displayed trends for increased lung cancer risk. Illicit drug use was not associated with increased lung cancer risk. Among HIV-infected persons, smoking remained the major risk factor; CD4 cell count and HIV load were not strongly associated with increased lung cancer risk, and trends for increased risk with use of highly active antiretroviral therapy were not significant. HIV infection is associated with significantly increased risk for developing lung cancer, independent of smoking status. Nielsen, C; Teglbjærg, Lars Stubbe; Pedersen, C HIV seronegative individuals with high-risk behavior were tested for HIV infection by sensitive virus isolation techniques using T4 lymphocytes and monocyte/macrophages, and by detection of proviral DNA using PCR with three different sets of nested primers. No evidence of HIV infection was found...... among the 31 seronegative high-risk subjects, either by virus isolation of by PCR (97.5% confidence limits, 0-11). Our results indicate that ongoing HIV infection in seronegative persons at high risk of infection is a rare event.... Mellins, Claude A.; Dolezal, Curtis; Brackis-Cott, Elizabeth; Nicholson, Ouzama; Warne, Patricia; Meyer-Bahlburg, Heino F. L. HIV-negative, inner-city adolescents with HIV-infected parents are considered to be at high risk for acquiring HIV themselves. Using a modified theory of health behavior, this study examined the effects of maternal HIV infection and psychosocial variables on the onset of sexual and drug risk behavior in 144 HIV-negative adolescents with and… Jensen Paul T; Sheth Siddharth H; Lahey Timothy Abstract Background The importance of depression as a complication of HIV infection is increasingly understood, and people living in rural areas are at increased risk for depression. However, it is not known whether living in rural areas amplifies the risk of depression in patients with HIV. Methods We compared the prevalence of depression between rural and metropolitan HIV patients seen at the Dartmouth-Hitchcock HIV Program in a retrospective cohort study. Using the validated Rural-Urban Co... Huba, GJ; Melchoir, LA; Greenberg, B; Trevithick, L; Feudo, R; Tierney, S; Sturdevant, M; Hodgins, A; Remafedi, G; Woods, ER; Wallace, M; Schneir, A; Kawata, AK; Brady, RE; Singer, B; Marconi, K; Wright, E; Panter, AT This article describes data from 4,111 males and 4,085 females participating in 10 HIV/AIDS service demonstration projects. The sample was diverse in age, gender, ethnicity, HIV status, and risk for HIV transmission. Logistic regression was used to determine the attributes that best predict Onyechi, Kay Chinonyelum Nwamaka; Eseadi, Chiedu; Okere, Anthony U; Otu, Mkpoikanke Sunday Exploring beliefs about personal risk for human immunodeficiency virus (HIV) infection is essential to understanding what motivates people to engage in behaviors that reduce or increase their risk of HIV infection. Therefore, the current study's objective was to examine the effects of a Rational-Emotive Health Education Program (REHEP) on HIV risk perceptions among in-school adolescents in Anambra State, Nigeria.Forty-four participants were identified as having high-risk perceptions about HIV infection through a self-report questionnaire and met the inclusion criteria. The treatment process was guided by a REHEP manual and consisted of 8 weeks of full intervention and 2 weeks of follow-up meetings that marked the end of intervention. The study used repeated measures analysis of variance to assess improvements in individual participants and across control and treatment group risk perceptions after the intervention.HIV risk perceptions of in-school adolescents did not differ across the treatment and control groups at baseline. Through REHEP, HIV risk perceptions significantly reduced in the treatment group compared to those in the control group. REHEP had significant effect on HIV risk perceptions of in-school adolescents exposed to treatment group, despite their sex. Religious background did not determine the significant effect of REHEP on HIV risk perceptions of in-school adolescents in the treatment group.Follow-up studies that would use a REHEP to assist client population from other parts of the country to promote HIV risk reduction, especially among those with high-risk behavior, are needed in Nigeria. Rountree, Michele A; Granillo, Teresa; Bagwell-Gray, Meredith Latina women in the United States are vulnerable to two intersecting public health concerns: intimate partner violence (IPV) and subsequent risk for HIV/AIDS infection. Examination of the cultural and contextual life factors of this understudied population is crucial to developing culturally relevant HIV interventions. Focus groups with Latinas (15 monolingual; 10 bilingual) who have experienced IPV were conducted. Monolingual and bilingual Latinas endorsed that they were concerned about HIV infection, naming partner infidelity and experiences of forced and coerced sex as primary reasons for their concern. However, monolingual participants had lower levels of HIV knowledge, spending much time discussing myths of HIV infection, whereas bilingual participants spent more time discussing specific prevention techniques, including challenges related to the violence in their relationships. These findings suggest that HIV/AIDS prevention programs for Latinas need to pay close attention to the different historical, contextual, and cultural experiences of this at-risk group of women. © The Author(s) 2015. Clark, JL; Konda, KA; Segura, ER; Salvatierra, HJ; Leon, SR; Hall, ER; Caceres, CF; Klausner, JD; Coates, TJ Objectives To assess the prevalence of sexually transmitted infections (STIs), frequency of sexual risk behaviors, and relationship between knowledge of HIV infection status and sexual risk behavior among HIV-infected men who have sex with men (MSM) attending an STI clinic in Peru. Methods We recruited a convenience sample of 559 MSM from a municipal STI clinic in Lima, Peru. Participants completed a survey and provided blood for HIV, Syphilis, and HSV-2 antibody testing, and urine for gonorrhea and chlamydia nucleic acid testing. Results Among 124 HIV-infected MSM, 72.6% were aware of their HIV-infected status. Active syphilis (RPR≥1:8) was diagnosed in 21.0% of HIV-infected participants, HSV-2 in 79.8%, urethral gonorrhea in 1.6%, and chlamydia in 1.6%. Among 41 participants reporting insertive anal intercourse with their last sex partner, 34.2% did not use a condom. Of 86 participants reporting receptive anal intercourse, 25.6% did not use a condom. At least one episode of insertive unprotected anal intercourse (UAI) with an HIV-uninfected partner during the previous six months was reported by 33.6% (35/104) of participants, and receptive UAI with an HIV-uninfected partner by 44.6% (45/101). No difference in frequency of UAI, with HIV-uninfected or HIV-infected partners, was observed between men who knew their serostatus compared with those who were previously undiagnosed (all p-values >0.05). Conclusions HIV-infected MSM in Peru engaged in high-risk behaviors for spreading HIV and STIs. Knowledge of HIV-infected status was not associated with a decreased frequency of unprotected anal intercourse. Additional efforts to reduce risk behavior after the diagnosis of HIV infection are necessary. PMID:19028945 Ndugwa Kabwama, Steven; Berg-Beckhoff, Gabriele This systematic review tries to elucidate the association between what people know about HIV/AIDS and how they perceive their risk of infection. The initial search for articles yielded 1,595 abstracts, 16 of which met the inclusion criteria. Five studies found a positive correlation, four reported...... a negative correlation and seven found no association between knowledge and risk perception. It was found that the existing psychometrically sound measure of HIV/AIDS risk perception had not been used in any of the studies. The context in which the risk is assessed is pivotal to whether an association...... between knowledge and the perceived risk is found. Biases in judgement such as optimistic bias, psychological distancing, anchoring bias and overconfidence also explain how knowledge may fail to predict risk perception. It was concluded that the association between HIV/AIDS knowledge and risk perception... Poudel, Krishna C; Buchanan, David R; Poudel-Tandukar, Kalpana We evaluated the efficacy of a sexual risk reduction intervention utilizing protection motivation and social cognitive theories to address knowledge, threat and coping appraisals, and condom use intentions among HIV-positive individuals in Nepal. Using a quasi-experimental research design, we assigned 277 participants to intervention (n=146) and control (n=131) groups. The intervention group received six sessions on sexual risk reduction strategies and the control group six sessions on medication adherence, smoking, and mental health. Data were collected at baseline and immediately after the intervention. Results indicate that the sexual risk reduction intervention produced a significant increase in HIV transmission knowledge, perceived threat and coping appraisals, and intentions to use condoms with regular, HIV-positive, and HIV-negative partners. The positive effects of the intervention remained significant after adjusting for baseline scores and other potential confounders. In conclusion, our theory-based sexual risk reduction intervention was effective in improving HIV transmission knowledge, perceived threat and coping appraisals, and condom use intentions. Further studies are needed to evaluate the long-term efficacy of the intervention in increasing protection motivation and maintaining preventive behaviors. Determinants of Self-Perceived HIV Risk in Young South Africans Engaged in Concurrent Sexual Relationships. C Kenyon, S Zondo, M Badri. Abstract. Concurrent sexual partnerships are increasingly believed to be a key factor explaining the size of the HIV pandemic in Southern and Eastern Africa. Little, however, is ... There is paucity of data describing the risk factors for anaemia among HIV infected children in Tanzania. This cross sectional study was carried out to determine the contributing factors for anaemia among HIV-infected children attending Muhimbili National Hospital in Dar es Salaam. Both univariate and multivariate logistic ... Heaphy, Emily Lenore Goldman; Loue, Sana; Sajatovic, Martha; Tisch, Daniel J Latinos in the United States have been identified as a high-risk group for depression, anxiety, and substance abuse. HIV/AIDS has disproportionately impacted Latinos. Review findings suggest that HIV-risk behaviors among persons with severe mental illness (SMI) are influenced by a multitude of factors including psychiatric illness, cognitive-behavioral factors, substance use, childhood abuse, and social relationships. To examine the impact of psychiatric and social correlates of HIV sexual risk behavior in Puerto Rican women with SMI. Data collected longitudinally (from 2002 to 2005) in semi-structured interviews and from non-continuous participant observation was analyzed using a cross-sectional design. Bivariate associations between predictor variables and sexual risk behaviors were examined using binary and ordinal logistic regression. Linear regression was used to examine the association between significant predictor variables and the total number of risk behaviors the women engaged in during the 6 months prior to baseline. Just over one-third (35.9%) of the study population (N = 53) was diagnosed with bipolar disorder and GAF scores ranged from 30 to 80 with a median score of 60. Participants ranged in age from 18 to 50 years (M = 32.6 ± 8.7), three-fourths reported a history of either sexual or physical abuse or of both in childhood, and one-fourth had abused substances in their lifetimes. Bivariate analyses indicated that psychiatric and social factors were differentially associated with sexual risk behaviors. Multivariate linear regression models showed that suffering from increased severity of psychiatric symptoms and factors and living below the poverty line are predictive of engagement in a greater number of HIV sexual risk behaviors. Puerto Rican women with SMI are at high risk for HIV infection and are in need of targeted sexual risk reduction interventions that simultaneously address substance abuse prevention and treatment, childhood abuse, and the Full Text Available The purpose of this paper is to explore the perceptions of self-reported HIV testing and risk behavior among sexually active adolescents and youth in secondary schools in Kampala Uganda. This was a cross-sectional survey conducted between June and October 2010 among secondary school students in Kampala, Uganda. Forty eight (48 students across the 54 schools were purposively selected for the qualitative sub-study based on their responses to particular questions. We thematically analyzed 28 interviews for our qualitative study using Nvivo software. Drug and alcohol use coupled with peers pressure impaired students’ perceptions towards HIV risk and therefore increased their susceptibility to HIV risk behaviors. Of the 28 scripts analyzed, 82% (23/28 had ever had sexual partners, 79% (22/28 were currently sexually active, and 57% (16/28 had ever been tested for HIV. In conclusion, most adolescents interviewed did not perceive HIV testing to be important to HIV prevention and reported low perception of susceptibility to HIV infection. Development of an adolescent HIV prevention model is important in improving uptake of HIV services. German, Danielle; Latkin, Carl A. This study evaluated a cumulative and syndromic relationship among commonly co-occurring vulnerabilites (homelessness, incarceration, low-income, residential transition) in association with HIV-related risk behaviors among 635 low-income women in Baltimore. Analysis included descriptive statistics, logistic regression, latent class analysis and latent class regression. Both methods of assessing multidimensional instability showed significant associations with risk indicators. Risk of multiple partners, sex exchange, and drug use decreased significantly with each additional domain. Higher stability class membership (77%) was associated with decreased likelihood of multiple partners, exchange partners, recent drug use, and recent STI. Multidimensional social vulnerabilities were cumulatively and synergistically linked to HIV risk behavior. Independent instability measures may miss important contextual determinants of risk. Social stability offers a useful framework to understand the synergy of social vulnerabilities that shape sexual risk behavior. Social policies and programs aiming to enhance housing and overall social stability are likely to be beneficial for HIV prevention. PMID:21259043 Berenson, Kathy R; Paprocki, Christine; Thomas Fishman, Marget; Bhushan, Devika; El-Bassel, Nabila; Downey, Geraldine The psychological processes associated with HIV infection in long-term relationships differ from those operative in casual sexual encounters, and relatively little research has considered the aspects of personality applicable in the ongoing heterosexual relationships in which women are at greatest risk. Sensitivity to rejection has been linked with efforts to prevent rejection at a cost to the self and, therefore, may be relevant to the health risks that many women incur in relationships. We examined the association of rejection sensitivity with women's sexual risk behavior in a sample of women at heightened risk for HIV exposure. Women in long-term heterosexual relationships (N = 159) were recruited for study participation in the hospital emergency room serving a low-income neighborhood in New York City, in 2001-2003. Rejection sensitivity and known HIV risk factors were assessed using verbally administered questionnaires. Rejection sensitivity was associated with lower perceived relationship power and, in turn, more frequent unprotected sex with a partner perceived to be at risk for HIV. These results held when controlling for other HIV risk factors including partner violence, economic dependence, and substance use. Understanding the association of rejection concerns with lower perceived personal power in relationships may be important for HIV prevention. The aim of this study was to identify factors affecting HIV risk reduction among 150 Black and 150 White South Africans chosen by systematic random sampling. Main outcome measures included sexual behaviour and condom use, knowledge about correct condom use, intention of condom use, behavioural norms, attitudes, normative beliefs, and subjective norms about condoms, HIV/AIDS health beliefs, and HIV risk behaviour. Bivariate analysis gave positive significant relations among being single, age, ... Full Text Available In Kasensero fishing community, home of the first recorded case of HIV in Uganda, HIV transmission is still very 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 drivers for the high HIV transmission at Kasensero from the perspective of fishermen and other community members to inform future policy and preventive interventions.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 were conducted during April-September 2014. Content analysis was performed to identify recurrent themes.The socio-economic risk factors for high HIV transmission in Kasensero fishing community cited were multiple and cross-cutting and categorized into the following themes: power of money, risk denial, environmental triggers and a predisposing lifestyle and alcoholism and drug abuse. Others were: peer pressure, poor housing and the search for financial support for both the men and women which made them vulnerable to HIV exposure and or risk behavior.There is a need for context specific combination prevention interventions in Kasensero that includes the fisher folk and other influential community leaders. Such groups could be empowered with the knowledge and social mobilization skills to fight the negative and risky behaviors, perceptions, beliefs, misconceptions and submission attitudes to fate that exposes the community to high HIV transmission. There is also need for government/partners to ensure effective policy implementation, life jackets for all fishermen, improve the poor housing at the community so as to reduce overcrowding and other housing related predispositions to high HIV rates at the community. Work place AIDS-competence teams have been successfully used to address high HIV transmission in similar Laguna-Torres, V Alberto; Aguayo, Nicolás; Aguilar, Gloria; Ampuero, Julia S; Galeano, Adolfo; Barboza, Alma; Villafane, Margarita; Jiménez, Liliana; Perez, Juan; Kochel, Tadeusz J; Halsey, Eric S Between July 2005 and January 2006 we evaluated 1248 Paraguayan active duty military volunteers. Participants provided a blood sample for HIV testing and answered an anonymous survey. HIV seroprevalence was 0.4% (5 of 1248) among participants. The median age at first sexual intercourse was 16 years. Only 14.8% of participants reported condom use with every sexual encounter. Military students used condoms the most. Participants older than 45 years, compared with younger participants, had a fourfold (adjusted odds ratio 4.3) increased risk of not using condoms. Men were less likely to use a condom, more likely to practice anal intercourse, and had more sexual partners than women. Officers and non-commissioned officers were identified to have a twofold (as measured by adjusted odds ratio = 2.00 and 2.22, respectively) increased risk of having more than two sexual partners in the last month compared with students. Both officers and non-commissioned officers were twice as likely as students to practice anal intercourse. Despite the high-risk behaviours reported by those surveyed, HIV seroprevalence in active duty personnel was low. Future efforts should emphasize on the correct condom use keeping focus on the high-risk behaviours of groups at risk, and on routinely testing the military personnel for HIV. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav. Toxoplasmosis is a disease caused by a protozoal parasite: Toxoplasma gondii . This infection can cause severe illness when the organism is contracted congenitally or when it is reactivated in immunosuppressed people. In this paper we review for the first time prevalence and risk factors of T. gondii among pregnant women and HIV-infected adults in Morocco. A systematic review methodology was used to consult three databases: Pub Med, Science Direct and Google Scholar dated until 2015, regarding prevalence data and risk factors of infection among pregnant women and people living with HIV. Data collection and eligibility criteria were established in this paper. No statistical method was employed in this study. Our review resulted in a total of 6 publications meeting the inclusion criteria of prevalence and risk factors of toxoplasmosis in Morocco. Seropositive rates of T. gondii infection reach up to 51% in pregnant women. Risk factors that were reported included contact with soil, lack of knowledge about toxoplasmosis, and a low educational level. For HIV-infected adults, the limited data show a 62.1% prevalence rate of T. gondii .According to our review, there is still very little information on toxoplasmosis disease in pregnant women and HIV infected patients in Morocco. Further research on toxoplasmosis is needed to better ascertain the human disease burden in Morocco. Stockman, Jamila K.; Lucea, Marguerite B.; Campbell, Jacquelyn C. Coerced or forced sexual initiation and sexual intimate partner violence (sexual IPV) contribute significantly to a woman’s risk for HIV infection. This review systematically examines global research (n=21 studies) published since 2000 on the role of coerced/forced sexual initiation and sexual IPV on HIV risk in women. In predominantly low- and middle-income countries, coerced/forced sexual initiation was associated with HIV/STIs, multiple and high-risk sex partners, and no condom use. Most studies using behaviorally specific terms for sexual IPV found strong associations between sexual IPV and HIV risk behaviors. In contrast, studies using less specific definitions often failed to find these significant associations. To develop more comprehensive HIV prevention programs, future efforts should integrate behaviorally specific terms into assessing prevalence of sexual IPV and its association with HIV risk, consider cultural differences, and identify causal pathways between coerced or forced sexual initiation, HIV risk behaviors and HIV/STI infection. PMID:23143750 In order to examine the ways in which men's perceptions of their social surroundings influence how they experience and negotiate sexual risk, we conducted a qualitative study with 36 men who lived in London or Birmingham, had five or more male partners in the previous year and believed themselves to be HIV negative. Men were recruited into two sub-samples (18 men each). The high proximity group personally knew someone with HIV and had a positive sexual partner in the year prior to interview. The low proximity group had never personally known anyone with HIV and had never had a sexual partner who they knew or believed to be HIV positive. Data was collected via semi-structured interviews. Men in the low proximity groups used moral discourses to articulate beliefs and social norms around the disclosure of HIV which may act as a deterrent to sexual partners disclosing. Although most expected positive sexual partners to disclose, they had difficulty in articulating how they would respond to disclosure and how they would manage any consequent sexual risk. For the men in the high proximity group, living around HIV constituted a part of everyday life. Disclosure and discussion of HIV did not violate their social norms. The majority did not expect positive sexual partners to disclose to them and knew how they would respond to such disclosure if it occurred. Men in this group did not use moral discourses but talked practically about better and worse ways of managing disclosure. Proximity to HIV is mediated by strong social norms and self-perpetuating moral discourses which effectively creates a social divide between men who perceive themselves to be in low proximity to HIV and their HIV positive contacts and sexual partners. Men with perceived low proximity to HIV are appropriate as a target group for HIV prevention. Full Text Available OBJECTIVE: Determine the prevalence of metabolic abnormalities (MA and estimate the 10-year risk for cardiovascular disease (CVD among Latin American HIV-infected patients receiving highly active anti-retroviral therapy (HAART. METHODS: A cohort study to evaluate MA and treatment practices to reduce CVD has been conducted in seven Latin American countries. Adult HIV-infected patients with at least one month of HAART were enrolled. Baseline data are presented in this analysis. RESULTS: A total of 4,010 patients were enrolled. Mean age (SD was 41.9 (10 years; median duration of HAART was 35 (IQR: 10-51 months, 44% received protease inhibitors. The prevalence of dyslipidemia and metabolic syndrome was 80.2% and 20.2%, respectively. The overall 10-year risk of CVD, as measured by the Framingham risk score (FRF, was 10.4 (24.7. Longer exposure to HAART was documented in patients with dyslipidemia, metabolic syndrome and type 2 diabetes mellitus. The FRF score increased with duration of HAART. Male patients had more dyslipidemia, high blood pressure, smoking habit and higher 10-year CVD than females. CONCLUSIONS: Traditional risk factors for CVD are prevalent in this setting leading to intermediate 10-year risk of CVD. Modification of these risk factors through education and intervention programs are needed to reduce CVD. Full Text Available In South Africa social and behavioural communication interventions are a critical component of HIV/AIDS prevention, and numerous communication campaigns have been implemented intensively across the country through government initiatives and nongovernmental organisations over the past decade. The aim of this paper is to assess the reach of HIV and AIDS communication campaigns in conjunction with contributions to knowledge, attitudes, and HIV risk behaviours in the general population in South Africa. The sample included in this nationally representative cross-sectional survey was 13234 people aged 15–55 years. Overall, the study found that there was high exposure to 18 different HIV communication programmes (median 6 programmes and 14 programmes more than 30% across different age groups. Most programmes were more often seen or heard by young people aged between 15 and 24 years. In multivariate analysis, greater exposure to HIV mass communication programmes was associated with greater HIV knowledge, condom use at last sex, having tested for HIV in the past 12 months, and less stigmatizing attitude toward PLWHA. Schommers, Philipp; Gillor, Daniel; Hentrich, Marcus; Wyen, Christoph; Wolf, Timo; Oette, Mark; Zoufaly, Alexander; Wasmuth, Jan-Christian; Bogner, Johannes R; Müller, Markus; Esser, Stefan; Schleicher, Alisa; Jensen, Björn; Stoehr, Albrecht; Behrens, Georg; Schultze, Alexander; Siehl, Jan; Thoden, Jan; Taylor, Ninon; Hoffmann, Christian Outcome of HIV-infected patients with AIDS-related lymphomas has improved during recent years. However, data on incidence, risk factors, and outcome of relapses in AIDS-related lymphomas after achieving complete remission are still limited. This prospective observational multicenter study includes HIV-infected patients with biopsy- or cytology-proven malignant lymphomas since 2005. Data on HIV infection and lymphoma characteristics, treatment and outcome were recorded. For this analysis, AIDS-related lymphomas patients in complete remission were analyzed in terms of their relapse- free survival and potential risk factors for relapses. In total, 254 of 399 (63.7%) patients with AIDS-related lymphomas reached a complete remission with their first-line chemotherapy. After a median follow up of 4.6 years, 5-year overall survival of the 254 patients was 87.8% (Standard Error 3.1%). Twenty-nine patients relapsed (11.4%). Several factors were independently associated with a higher relapse rate, including an unclassifiable histology, a stage III or IV according to the Ann Arbor Staging System, no concomitant combined antiretroviral therapy during chemotherapy and R-CHOP-based compared to more intensive chemotherapy regimens in Burkitt lymphomas. In conclusion, complete remission and relapse rates observed in our study are similar to those reported in HIV-negative non-Hodgkin lymphomas. These data provide further evidence for the use of concomitant combined antiretroviral therapy during chemotherapy and a benefit from more intensive chemotherapy regimens in Burkitt lymphomas. Modifications to the chemotherapy regimen appear to have only a limited impact on relapse rate. Copyright © 2018 Ferrata Storti Foundation. Stephen Tully; Monica Cojocaru; Chris T. Bauch There has been growing use of highly active antiretroviral treatment (HAART) for HIV and significant progress in developing prophylactic HIV vaccines. The simplest theories of counterproductive behavioral responses to such interventions tend to focus on single feedback mechanisms: for instance, HAART optimism makes infection less scary and thus promotes risky sexual behavior. Here, we develop an agent based, age-structured model of HIV transmission, risk perception, and partner selection in a... Abubakar, Amina; Van de Vijver, Fons J R; Hassan, Amin S; Fischer, Ronald; Nyongesa, Moses K; Kabunda, Beatrice; Berkley, James A; Stein, Alan; Newton, Charles R Little is known of mental health outcomes among vertically HIV-infected or HIV-affected adolescents in Africa. The current study set out to describe depressive symptoms and their correlates among vertically HIV-infected and HIV-affected adolescents at the Kenyan Coast. 130 adolescents (vertically HIV-infected [n = 44], HIV-affected [n = 53], and unexposed [n = 33]) and their caregivers participated in this cross-sectional study. An adapted version of the Beck Depression Inventory-11 (BDI) was administered to examine depressive symptoms in both adolescents and caregivers, together with measures of sociodemographic, medical, and anthropometric characteristics. Our analysis indicated a main effect of HIV status on mean BDI scores in HIV-infected (18.4 [SD = 8.3) and HIV-affected (16.8 [SD = 7.3]) adolescents compared to the community controls (12.0 [SD = 7.9]), F (2, 127) = 6.704, P = .002, η 2 = .095. Post hoc analysis showed that BDI scores of HIV-infected adolescents were higher than those of community controls (P HIV-affected adolescents had BDI scores that were higher than those of community controls (P = .007). However, there was no difference in BDI scores between HIV-infected and HIV-affected adolescents (P = .304). A path analytic model indicated that cumulative psychosocial risk (orphanhood, family poverty, and caregiver depressive symptoms) were positive predictors of BDI scores among adolescents, while nutritional status had a limited role. Both HIV-infected and HIV-affected adolescents are at a high risk of experiencing depressive symptoms, largely due to the multiple psychosocial risk factors in their environment. The provision of adequate psychosocial support and counseling needs to become an integral part of the care program for adolescents from families living with HIV/AIDS at the Kenyan coast and other similar settings. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved. Short, Charlotte-Eve S; Shaw, Simon G; Fisher, Martin J; Walker-Bone, Karen; Gilleece, Yvonne C Rates of osteoporosis and fracture may be increased in HIV but there are few UK data. Our aim was to examine the prevalence of and risk factors for osteoporosis and fractures among a homogeneous cohort of well-characterized HIV-infected men. In total, 168 men were recruited, median age 45 years, 37 combination antiretroviral therapy (cART) naïve, 46 with exposed longer term (median >10 years). All participants provided information on bone health and underwent DEXA scanning. Osteopenia was found in 58% of subjects and osteoporosis in 12%; 14% reported fractures since HIV diagnosis. Number of fractures since HIV diagnosis was significantly increased among those with osteoporosis (OR 3.5, 95% CI 1.2-10.4, p = 0.018). Duration of infection greater than 13 years was significantly associated with osteoporosis. Duration of cART was associated in univariate but not multivariate analyses. Strategies to prevent osteoporosis and fractures in HIV will require attention to viral and lifestyle factors and not just cART. Stachowski, Courtney; Stephenson, Rob Men who have sex with men (MSM) remain disproportionately affected by the HIV epidemic in the US and estimates suggest that one to two-thirds of new infections occur among main partners. Previous research has focused on individual MSM and their risk for HIV, yet couples' ability to manage risk has been largely understudied. In particular, the role that homophobia plays in shaping the ability of gay male couples to cope with HIV risk is currently understudied. A sample of 447 gay/bisexual men with main partners was taken from a 2011 survey of gay and bisexual men in Atlanta. Linear regression models were fitted for three couples' coping outcome scales (outcome efficacy, couple efficacy, communal coping) and included indicators of homophobia (internalized homophobia and homophobic discrimination). Findings indicate that reporting of increased levels of internalized homophobia were consistently associated with decreased outcome measures of couples' coping ability regarding risk management. The results highlight the role that homophobia plays in gay male couples' relationships and HIV risk, extending the existing literature in the field of same-sex relationships as influenced by homophobia. Valdés, Baltica Cabieses; Lagunas, Lilian Ferrer; Villarroel, Luis Antonio; Acosta, Rosina Cianelli; Miner, Sarah; Silva, Margarita Bernales Objective To explore the relationship between knowledge level and occupational risk exposure to HIV/AIDS in primary care health workers. Methodology Analytical cross-sectional study. 720 health workers from Santiago answered a survey about HIV/AIDS that included: knowledge level (appropriate, inappropriate), occupational risk (with or without risk), and control variables (age, gender, health center, education and marital status). Descriptive and association analysis were performed. Odds Ratio (OR) was estimated through simple and multiple regressions logistics. Results 58.7% of the participants reported HIV occupational risk. 63.8% of the participants from the exposed group reported an appropriate level of knowledge, versus 36.1% of the non-exposed group (Adjusted OR of 3.1, IC95%OR: 2.0-4.8, p<0.0001). Technicians and cleaning staff reported a lower proportion of appropriate level of knowledge compared to the employees with college education (p<0.0001). Conclusion The level of HIV/AID occupational risk is directly associated with the level of knowledge of the disease. PMID:25284913 Barreto, Daniella; Shannon, Kate; Taylor, Chrissy; Dobrer, Sabina; Jean, Jessica St; Goldenberg, Shira M; Duff, Putu; Deering, Kathleen N This research aimed to determine the effect of food insecurity on sexual HIV risk with clients among youth sex workers (YSWs) sex workers (2010-2013). We examined the independent relationship between YSWs' food insecurity and being pressured into sex without a condom by clients ("client condom refusal"). Of 220 YSWs, 34.5 % (n = 76) reported client condom refusal over the 3.5-year study period and 76.4 % (n = 168) reported any food insecurity. Adjusting for other HIV risk pathways, food insecurity retained an independent effect on client condom refusal (AOR 2.08, 95 % CI 1.23-3.51), suggesting that food insecurity is significantly associated with HIV risk among YSWs. This study indicates a critical relationship between food insecurity and HIV risk, and demonstrates YSWs' particular vulnerability. Public policies for food assistance as a harm reduction measure may be key to addressing this disparity. Nelwan, Erni J; Indrati, Agnes K; Isa, Ahmad; Triani, Nurlita; Alam, Nisaa Nur; Herlan, Maria S; Husen, Wahid; Pohan, Herdiman T; Alisjahbana, Bachti; Meheus, Andre; Van Crevel, Reinout; van der Ven, Andre Jam Validated data regarding HIV-transmission in prisons in developing countries is scarce. We examined sexual and injecting drug use behavior and HIV and HCV transmission in an Indonesian narcotic prison during the implementation of an HIV prevention and treatment program during 2004-2007 when the Banceuy Narcotic Prison in Indonesia conducted an HIV transmission prevention program to provide 1) HIV education, 2) voluntary HIV testing and counseling, 3) condom supply, 4) prevention of rape and sexual violence, 5) antiretroviral treatment for HIV-positive prisoners and 6) methadone maintenance treatment. During a first survey that was conducted between 2007 and 2009, new prisoners entered Banceuy Narcotics Prison were voluntary tested for HIV and HCV-infection after written informed consent was obtained. Information regarding sexual and injecting risk behavior and physical status were also recorded at admission to the prison. Participants who tested negative for both HIV and HCV during the first survey were included in a second survey conducted during 2008-2011. During both surveys, data on mortality among HIV-seropositive patients were also recorded. All HIV-seropositive participants receive treatment for HIV. HIV/ AIDS-related deaths decreased: 43% in 2006, 18% in 2007, 9% in 2008 and 0% in 2009. No HIV and HCV seroconversion inside Banceuy Narcotic Prison were found after a median of 23 months imprisonment (maximum follow-up: 38 months). Total of 484.8 person-years observation was done. Participants reported HIV transmission risk-behavior in Banceuy Prison during the second survey was low. After implementation of HIV prevention and treatment program, no new HIV or HCV cases were detected and HIV-related mortality decreased. Fisher, Colleen M. Young sexual minority males are among those at highest risk for HIV infection, yet we know relatively little about the impact of sexual identity development on HIV risk. This study used cross-sectional data to investigate factors associated with HIV-related sexual risk among a sample of sexual minority males (n = 156), ages 14 to 21 years, using… Adams, Leah M; Stuewig, Jeffrey B; Tangney, June P The present study explored the relationship between borderline personality disorder (BPD) features and preincarceration HIV risk behaviors in a sample of 499 (70% male) jail inmates, as well as gender differences in these associations. Elevated levels of BPD symptomatology were present among male and female participants, though there was considerable variance observed in participants' BPD symptoms and HIV risk behaviors. In the full sample, BPD features were positively associated with a variety of HIV risk behaviors, including injection drug use and frequency of unprotected sex with high risk partners and under high risk circumstances. Gender moderated only 2 relationships between BPD features and HIV risk behaviors, with a stronger association between BPD features and number of sexual partners, and BPD features and frequency of unprotected sex while under the influence of alcohol or drugs for women, relative to men. Taken together, these findings suggest that programs targeting HIV risk within correctional populations may benefit from considering the role of BPD features, particularly emotion regulation difficulties and impulsivity, in influencing HIV risk behaviors among both women and men. (c) 2016 APA, all rights reserved). Khan Omar A Full Text Available Abstract Background Recent surveillance data from Bangladesh indicate rising HIV infection among intravenous drug users (IDU in the country. We suggest a likely association between HIV risk factors in this group and other groups, such as males who have sex with males (MSM. Methods Data on MSM in Bangladesh was collected and analyzed from numerous primary and secondary sources, including government ministries, non-profit health organizations, and personal communications. Results The overall prevalence of HIV in Bangladesh is relatively low, but surveillance data indicate that infection has reached significant proportions in certain high-risk groups and may soon spread to other groups, specifically MSM. Conclusion The epidemiology of HIV infection in other countries suggests that increasing rates of HIV in higher-risk populations can precede an epidemic in the general population. We review the data concerning MSM, IDU and HIV in Bangladesh from a variety of sources and propose ways to prevent HIV transmission. Faber, Mette Tuxen; Munk, Christian; Mwaiselage, Julius In a cross-sectional study of 3,424 women from urban (Dar es Salaam) and rural (Pwani, Mwanza, and Mtwara) Tanzania, conducted in 2008–2009, we investigated risk factors for human immunodeficiency virus (HIV) and the association between different measures of human papillomavirus (HPV) and HIV...... positivity. Study participants were interviewed about socio-demographic and reproductive factors and sexual behavior. Blood samples were tested for HIV, and the women underwent a gynecological examination. HPV status was determined by Hybrid Capture 2, and HPV genotyping was performed using the LiPA Extra...... test. Multivariable logistic regression models estimating odds ratios (OR) and 95% confidence intervals (CI) were used. The overall HIV prevalence was 10.2%. HIV-positive women were more likely to have high-risk (HR) HPV detected (OR = 4.11; 95% CI: 3.23–5.24) and clinically visible genital warts (OR... Morrison, Charles S.; Chen, Pai-Lien; Kwok, Cynthia; Baeten, Jared M.; Brown, Joelle; Crook, Angela M.; Van Damme, Lut; Delany-Moretlwe, Sinead; Francis, Suzanna C.; Friedland, Barbara A.; Hayes, Richard J.; Heffron, Renee; Kapiga, Saidi; Karim, Quarraisha Abdool; Karpoff, Stephanie; Kaul, Rupert; McClelland, R. Scott; McCormack, Sheena; McGrath, Nuala; Myer, Landon; Rees, Helen; van der Straten, Ariane; Watson-Jones, Deborah; van de Wijgert, Janneke H. H. M.; Stalter, Randy; Low, Nicola Background Observational studies of a putative association between hormonal contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC. Methods and Findings Eligible studies measured HC exposure and incident HIV infection prospectively using standardized measures, enrolled women aged 15–49 y, recorded ≥15 incident HIV infections, and measured prespecified covariates. Our primary analysis estimated the adjusted hazard ratio (aHR) using two-stage random effects meta-analysis, controlling for region, marital status, age, number of sex partners, and condom use. We included 18 studies, including 37,124 women (43,613 woman-years) and 1,830 incident HIV infections. Relative to no HC use, the aHR for HIV acquisition was 1.50 (95% CI 1.24–1.83) for DMPA use, 1.24 (95% CI 0.84–1.82) for NET-EN use, and 1.03 (95% CI 0.88–1.20) for COC use. Between-study heterogeneity was mild (I2 HIV acquisition compared with COC use (aHR 1.43, 95% CI 1.23–1.67) and NET-EN use (aHR 1.32, 95% CI 1.08–1.61). Effect estimates were attenuated for studies at lower risk of methodological bias (compared with no HC use, aHR for DMPA use 1.22, 95% CI 0.99–1.50; for NET-EN use 0.67, 95% CI 0.47–0.96; and for COC use 0.91, 95% CI 0.73–1.41) compared to those at higher risk of bias (pinteraction = 0.003). Neither age nor herpes simplex virus type 2 infection status modified the HC–HIV relationship. Conclusions This IPD meta-analysis found no evidence that COC or NET-EN use increases women’s risk of HIV but adds to the evidence that DMPA may increase HIV risk, underscoring the need for additional safe and effective contraceptive options for women at Paula Matos Oliveira Full Text Available CONTEXT AND OBJECTIVE: The human immunodeficiency virus (HIV is frequently associated with high-grade intraepithelial neoplasia. Immunosuppression and high HIV viral load are the main risk factors for cervical intraepithelial neoplasia (CIN. The aim of this study was to determine the prevalence of CIN in HIV-infected women in Salvador, Bahia, Brazil, and to describe the risk factors in comparison with non-infected women. DESIGN AND SETTING: Cross-sectional study at the AIDS Reference Center of Bahia and the Gynecological Outpatient Clinic of Fundação Bahiana para o Desenvolvimento da Ciência, in Salvador, Bahia, Brazil. METHODS: Sixty-four HIV-infected women and 76 uninfected women from Salvador were enrolled between May 2006 and May 2007. Associations between CIN and presence of HIV infection, HIV viral load, proportion of T CD4+ lymphocytes and risk factors were evaluated. The independence of the risk factors was investigated using logistic regression. RESULTS: CIN was more prevalent among HIV-infected women than in the control group (26.6% versus 6.6%; P = 0.01. The odds ratio for CIN among HIV-infected women was 3.7 (95% confidence interval, CI: 1.23-11; P = 0.01, after adjusting for the following variables: age at first sexual intercourse, number of partners, number of deliveries and previous history of sexually transmitted disease. CONCLUSION: The prevalence of CIN among HIV-infected women was significantly higher than among women without HIV infection. HIV infection was the most important risk factor associated with the development of cervical lesions. Full Text Available Thirty years into the HIV&AIDS pandemic, the world is still striving to reduce new HIV infections and halve AIDS related deaths by 2015. However, sub-Saharan Africa still faces the burden of HIV infections as governments and private institutions try out different prevention strategies (UNAIDS 2011. Several scholars have argued that multiple concurrent sexual partnerships (MCSP pose the greatest risk for new HIV infections. Furthermore, research has also linked MCSPs to mobility and migration. This paper draws from the project ‘Sexual identities and HIV&AIDS: an exploration of international university students’ experiences” which employed memory work, photo-voice, drawings and focus group discussions with ten (5male and 5female Post Graduate international students at a South African university. Focussing on the data produced through memory work, I present university students’ lived-experience narratives of mobility and migration in relation to how they perceive MCSPs and HIV risk. The findings show how students construct their gendered and sexual identities in a foreign context and how these constructions intersect with their choices of sexual relationships and HIV risk. I argue from the findings that Higher Education Institutions should be treated as high risk ‘spaces of vulnerability’ and hence health support services and HIV intervention programming policies should be geared towards addressing such vulnerabilities in order to create sustainable teaching and learning environments that allow for all students to explore their full capabilities. Henrickson, Mark; Dickson, Nigel; Mhlanga, Fungai; Ludlam, Adrian The AfricaNZ Health project aimed explore HIV risks in Black African communities in NZ with a view to informing HIV infection prevention and health promotion programs. AfricaNZ Health was completed in two phases. The first developed desk estimates of the resident Black African population in New Zealand, and Africans living with HIV. The second comprised two arms: an anonymous survey administered at African community events and a series of focus groups around the country. High levels of knowledge and positive attitudes about HIV were more often found in older than younger age groups. Condom use was higher in the younger group than in older age groups. Traditional attitudes still inform some beliefs about HIV. Stigma about HIV and anyone at risk for HIV remains very high among Africans. Western sexual identity constructs are not meaningful. A culturally informed strategy for risk and stigma reduction is urgently needed. The existing prevention and care infrastructure, informed by MSM experiences, must address increased risk to Black African new settlers, but this is not a reason to discriminate or further stigmatise an already vulnerable population. © 2014 Public Health Association of Australia. Maughan-Brown, Brendan; Venkataramani, Atheendar S We examined whether knowledge of the HIV-protective benefits of male circumcision (MC) led to risk compensating behavior in a traditionally circumcising population in South Africa. We extend the current literature by examining risk compensation among women, which has hitherto been unexplored. We used data on Xhosa men and women from the 2009 Cape Area Panel Study. Respondents were asked if they had heard that MC reduces a man's risk of contracting HIV, about their perceived risk of contracting HIV, and condom use. For each gender group we assessed whether risk perception and condom use differed by knowledge of the protective benefits of MC using bivariate and then multivariate models controlling for demographic characteristics, HIV knowledge/beliefs, and previous sexual behaviors. In a further check for confounding, we used data from the 2005 wave to assess whether individuals who would eventually become informed about the protective benefits of circumcision were already different in terms of HIV risk perception and condom use. 34% of men (n=453) and 27% of women (n=690) had heard that circumcision reduces a man's risk of HIV infection. Informed men perceived slightly higher risk of contracting HIV and were more likely to use condoms at last sex (pwomen perceived lower HIV risk (pwomen but not men. Further attention should be paid to the role of new information regarding MC, and drivers of HIV risk more broadly, in modulating sexual behavior among women. Despite this possibility, there are surprisingly few definitive studies that examine the effects of socioeconomic status on HIV risk and prevention behaviours among youth in South Africa. Using household survey data collected in 2001, this study investigates how socioeconomic disadvantage has influenced the sexual ... Full Text Available Background. Little attention has been paid to the role of poor mental health among young people with regard to HIV risk behaviour and HIV prevention in Africa. Objective. To determine the association between mental health, substance use and HIV sexual risk behaviour among a sample of university students in South Africa. Methods. A cross-sectional survey was conducted among undergraduate students who were recruited conveniently from public campus venues at the University of Limpopo Medical University of Southern Africa (Medunsa campus. The sample included 722 university students (57.6% men and 42.4% women with a mean age of 21.7 years (standard deviation ±8.8. Results. Of the 722 students, 39.5% reported depression, 23.4% screened positive for post-traumatic stress disorder (PTSD, 22% reported hazardous or harmful alcohol use, 33% reported ≥2 sexual partners in the past 12 months, 50% reported inconsistent condom use, 46% reported unknown HIV status of a sexual partner and 20% reported alcohol use in the context of sex in the past 3 months. In multivariate analysis, HIV risk behaviour was associated with, among men, hazardous or harmful alcohol use and having screened positive for PTSD, and among women, being in the 4th or more year of study and current cannabis use. Conclusion. Poor mental health, including substance use, was found to be associated with HIV risk behaviour. Co-ordinated mental health and sexual and reproductive health services that meet the needs of university students would be desirable. Agrawal, Alpna; Bloom, Shelah S; Suchindran, Chirayath; Curtis, Siân; Angeles, Gustavo Gender inequality is a long-recognized driver of the HIV epidemic. However, few studies have investigated the association between gender-based power and HIV risk in India, which has the world's third largest HIV epidemic. Population-based data collected in 2003 from 3,385 couples residing in Uttar Pradesh and Uttarakhand, North India, were used to examine associations between gender-based power (wife's autonomy and husband's inequitable gender attitudes) and indicators of couples' HIV risk (whether the husband had had premarital sex with someone other than his eventual spouse, extramarital sex in the past year or STI symptoms in the past year). Structural equation modeling was used to create composite variables for the gender-based power measures and test their associations with HIV risk measures. Twenty-four percent of husbands had had premarital sex, 7% had had extramarital sex in the past year and 6% had had STI symptoms in the past year. Structural equation models indicated that wives who reported higher levels of autonomy were less likely than other wives to have husbands who had had extramarital sex in the past year (direct association) or STI symptoms in the past year (indirect association). Moreover, husbands who endorsed more inequitable gender attitudes were more likely than others to report having had premarital sex with someone other than their spouse, which in turn was associated with having had extramarital sex and STI symptoms in the past year. If the associations identified in this study reflect a causal relationship between gender-based power and HIV risk behavior, then HIV prevention programs that successfully address inequitable gender roles may reduce HIV risks in North India. Kerr, Jelani C; Valois, Robert F; Siddiqi, Arjumand; Vanable, Peter; Carey, Michael P; DiClemente, Ralph J; Romer, Daniel; Brown, Larry K; Farber, Naomi B; Salazar, Laura F Although region and neighborhood condition's effect on HIV/sexually transmitted infection (STI) risk has been studied separately, there is little research examining their interplay. African American adolescents (n = 1,602) from four matched cities in the Northeastern and Southeastern US completed Audio Computer Assisted Self-Interviews and submitted biospecimen samples to detect Sexually Transmitted Infections (chlamydia, gonorrhea, and trichomonas). Logistic and negative binomial regressions determined HIV/STI risk differences by region, neighborhood stress, and stress-region dyads. Northeastern participants demonstrated lower HIV/STI risk while participants from higher stress neighborhoods exhibited greater risk. Relationships between neighborhood condition and ever having anal sex (p use (p partners (p partners than participants in comparable Southeastern neighborhoods (p risk. Mahmud, Ghazala; Abbas, Shazra HIV is an epidemic quite unlike any other, combining the problems of a lifelong medical disease with immense social, psychological, economic and public health consequences. Since we are living in a global village where human interactions has become fast and frequent, diseases like HIV are no more alien to us. HIV/AIDS in Pakistan is slowly gaining recognition as a public health issue of great importance. Objectives of this study were to determine the prevalence of HIV in pregnant women identified with a high risk factor/behaviour at a tertiary care hospital. It is a Descriptive study. All pregnant women attending antenatal booking clinic were assessed via a pre-designed 'Risk assessment questionnaire'. Women identified with a risk factor were offered HIV Rapid screening test (Capillus HIV1/2). Positive (reactive) results on screening test were confirmed with ELISA. During the study period (March 2007-May 2008), out of 5263 antenatal bookings 785 (14%) women were identified with a risk factor. HIV screening test was done in 779 (99%), and 6 women refused testing. Three women (0.3%) were found positive (reactive) on screening. Two out of 3 women were confirmed positive (0.2%) on ELISA. Husbands of both women were tested and one found positive (migrant from Dubai). Second women had history of blood transfusion. Her husband was HIV negative. During the study period, in addition to 2 pregnant women diagnosed as HIV positive through ANC risk screening, 6 confirmed HIV positive women, found pregnant were referred from 'HIV Treatment Centre', Pakistan Institute of Medical Sciences (PIMS) to Prevention of Parent to Child Transmission (PPTCT) centre for obstetric care. Spouses of 5 out of 6 had history of working abroad and extramarital sexual relationships. All positive (8) women were referred to PPTCT centre for further management. A simple 'Risk Assessment Questionnaire' can help us in identifying women who need HIV screening. Sexual transmission still remains the Rotger, Margalida; Glass, Tracy R.; Junier, Thomas; Lundgren, Jens; Neaton, James D.; Poloni, Estella S.; van 't Wout, Angélique B.; Lubomirov, Rubin; Colombo, Sara; Martinez, Raquel; Rauch, Andri; Günthard, Huldrych F.; Neuhaus, Jacqueline; Wentworth, Deborah; van Manen, Danielle; Gras, Luuk A.; Schuitemaker, Hanneke; Albini, Laura; Torti, Carlo; Jacobson, Lisa P.; Li, Xiuhong; Kingsley, Lawrence A.; Carli, Federica; Guaraldi, Giovanni; Ford, Emily S.; Sereti, Irini; Hadigan, Colleen; Martinez, Esteban; Arnedo, Mireia; Egaña-Gorroño, Lander; Gatell, Jose M.; Law, Matthew; Bendall, Courtney; Petoumenos, Kathy; Rockstroh, Jürgen; Wasmuth, Jan-Christian; Kabamba, Kabeya; Delforge, Marc; De Wit, Stephane; Berger, Florian; Mauss, Stefan; de Paz Sierra, Mariana; Losso, Marcelo; Belloso, Waldo H.; Leyes, Maria; Campins, Antoni; Mondi, Annalisa; De Luca, Andrea; Bernardino, Ignacio; Barriuso-Iglesias, Mónica; Torrecilla-Rodriguez, Ana; Gonzalez-Garcia, Juan; Arribas, José R.; Fanti, Iuri; Gel, Silvia; Puig, Jordi; Negredo, Eugenia; Gutierrez, Mar; Domingo, Pere; Fischer, Julia; Fätkenheuer, Gerd; Alonso-Villaverde, Carlos; Macken, Alan; Woo, James; McGinty, Tara; Mallon, Patrick; Mangili, Alexandra; Skinner, Sally; Wanke, Christine A.; Reiss, Peter; Weber, Rainer; Bucher, Heiner C.; Fellay, Jacques; Telenti, Amalio; Tarr, Philip E. Background Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the setting of HIV infection. Methods In the general population, 23 common single-nucleotide polymorphisms (SNPs) were shown to be associated with CAD through genome-wide association analysis. Using the Metabochip, we genotyped 1875 HIV-positive, white individuals enrolled in 24 HIV observational studies, including 571 participants with a first CAD event during the 9-year study period and 1304 controls matched on sex and cohort. Results A genetic risk score built from 23 CAD-associated SNPs contributed significantly to CAD (P = 2.9×10−4). In the final multivariable model, participants with an unfavorable genetic background (top genetic score quartile) had a CAD odds ratio (OR) of 1.47 (95% confidence interval [CI], 1.05–2.04). This effect was similar to hypertension (OR = 1.36; 95% CI, 1.06–1.73), hypercholesterolemia (OR = 1.51; 95% CI, 1.16–1.96), diabetes (OR = 1.66; 95% CI, 1.10–2.49), ≥1 year lopinavir exposure (OR = 1.36; 95% CI, 1.06–1.73), and current abacavir treatment (OR = 1.56; 95% CI, 1.17–2.07). The effect of the genetic risk score was additive to the effect of nongenetic CAD risk factors, and did not change after adjustment for family history of CAD. Conclusions In the setting of HIV infection, the effect of an unfavorable genetic background was similar to traditional CAD risk factors and certain adverse antiretroviral exposures. Genetic testing may provide prognostic information complementary to family history of CAD. PMID:23532479 Bloom, Shelah S.; Agrawal, Alpna; Singh, Kaushalendra K.; Suchindran, Chirayath M. This study investigated the distribution and determinants of HIV risks among married couples in North India. Gender inequality emerged as a potential driver of HIV risks in this region. Data collection took place in 2003 in a probability survey of 3,385 couples living in India’s most populous state – Uttar Pradesh – and Uttaranchal. Couples’ analyses utilizing generalized estimating equations showed that compared with husbands, wives were less knowledgeable about HIV (OR=0.31, 95% CI= 0.27–0.... Chhim, Srean; Macom, John; Pav, Chettana; Nim, Nirada; Yun, Phearun; Seng, Sopheap; Chhim, Kolab; Tuot, Sovannary; Yi, Siyan Early HIV diagnosis and initiation onto antiretroviral therapy may prevent ongoing spread of HIV. Risk Tracing Snowball Approach (RTSA) has been shown to be effective in detecting new HIV cases in other settings. The main objective of this study is to evaluate the effectiveness of RTSA in increasing the rate of newly identified HIV cases among high-risk populations. Our second objective was to evaluate the effectiveness of RTSA, as compared to the walk-in group, in increasing the number of HIV tests and early case detection. This study was conducted from April 1 to September 30, 2016 at two NGO clinics in Phnom Penh, Cambodia. Respondent driven sampling method was adapted to develop RTSA to reach high-risk populations, including key populations and the general population who have social connections with key populations. Bivariate and multivariate logistic regression analyses were conducted. During the implementation period, 721 clients walked in for HIV testing (walk-in group), and all were invited to be seeds. Of the invited clients, 36.6% agreed to serve as seeds. Throughout the implementation, 6195 coupons were distributed to seeds or recruiters, and resulted in 1572 clients visiting the two clinics with coupons (RTSA group), for a coupon return rate of 25.3%. The rate of newly identified HIV cases among the RTSA group was significantly lower compared to that in walk-in group. However, the highest number of newly identified HIV cases was found during the implementation period, compared to both pre- and post-implementation period. Although statistically not significant, the mean CD4 count of newly identified HIV cases detected through RTSA was almost 200 cells/mm3 higher than that in the walk-in group. Although the rate of newly identified HIV cases among the RTSA group was lower than that in the walk-in group, the inclusion of RTSA in addition to the traditional walk-in method boosted new HIV case detection in the two participating clinics. A higher mean CD4 Kurth, Ann E; Spielberg, Freya; Cleland, Charles M; Lambdin, Barrot; Bangsberg, David R; Frick, Pamela A; Severynen, Anneleen O; Clausen, Marc; Norman, Robert G; Lockhart, David; Simoni, Jane M; Holmes, King K Evaluate a computerized intervention supporting antiretroviral therapy (ART) adherence and HIV transmission prevention. Longitudinal randomized controlled trial. An academic HIV clinic and a community-based organization in Seattle. In a total of 240 HIV-positive adults on ART, 209 completed 9-month follow-up (87% retention). Randomization to computerized counseling or assessment only, 4 sessions over 9 months. HIV-1 viral suppression, and self-reported ART adherence and transmission risks, compared using generalized estimating equations. Overall, intervention participants had reduced viral load: mean 0.17 log10 decline, versus 0.13 increase in controls, P = 0.053, and significant difference in ART adherence baseline to 9 months (P = 0.046). Their sexual transmission risk behaviors decreased (odds ratio = 0.55, P = 0.020), a reduction not seen among controls (odds ratio = 1.1, P = 0.664), and a significant difference in change (P = 0.040). Intervention effect was driven by those most in need; among those with detectable virus at baseline (>30 copies/mL, n = 89), intervention effect was mean 0.60 log10 viral load decline versus 0.15 increase in controls, P = 0.034. ART adherence at the final follow-up was 13 points higher among intervention participants versus controls, P = 0.038. Computerized counseling is promising for integrated ART adherence and safer sex, especially for individuals with problems in these areas. This is the first intervention to report improved ART adherence, viral suppression, and reduced secondary sexual transmission risk behavior. Robinson, William T; Zarwell, Meagan; Gruber, DeAnn Participants in the New Orleans arm of the National HIV Behavioral Surveillance of Heterosexuals at Increased Risk for HIV were asked about potential utilization of self-administered home-based tests for HIV. The majority (86%) would use a free home-based test if provided by mail and 99% would seek treatment based on a positive result. In addition, more than half of respondents would return test results in some format to the test provider, whereas most of the remaining participants preferred to discuss results only with their doctor. These findings point toward a potential method for advancing the National HIV/AIDS Strategy. Nadol, Patrick; Hoang, Tran Vu; Le, Linh-Vi; Nguyen, Tuan Anh; Kaldor, John; Law, Matthew In Vietnam's concentrated HIV epidemic, female sex workers (FSWs) are at increased risk for acquiring and transmitting HIV, largely through their male clients. A high proportion of males in Vietnam report being clients of FSWs. Studying HIV-related risk factors and prevalence among male clients is important, particularly given the potential for male clients to be a 'bridge' of HIV transmission to the more general population or to sex workers. Time-location sampling was used to identify FSW in Hanoi and Ho Chi Minh City, Vietnam's largest cities, in 2013-2014. Recruited FSWs were asked to refer one male client to the study. Demographic and risk behavior data were collected from FSWs and male clients by administered questionnaires. Biologic specimens collected from male clients were tested for HIV and opiates. Sampling weights, calculated based on the FSWs probability of being selected for enrolment, were applied to prevalence estimates for both FSWs and male clients. Logistic regression models were developed to obtain odds ratios for HIV infection among male clients. A total of 804 male clients were enrolled. Overall, HIV prevalence among male clients was 10.2%; HIV prevalence was 20.7% (95% confidence interval (CI) 15.0-27.9%) among those reporting a history of illegal drug use and 32.4% (95% CI 20.2-47.7%) among those with opioids detected in urine. HIV prevalence among male clients did not differ across 'bridging' categories defined by condom use with FSWs and regular partners over the previous 6 months. HIV among male clients was associated with a reported history of illegal drug use (OR 3.76; 95% CI 1.87-7.56), current opioid use (OR 2.55; 95% CI 1.02-6.36), and being referred by an FSW who self-reported as HIV-positive (OR 5.37; 95% CI 1.46-19.75). Self-reported HIV prevalence among enrolled FSWs was 2.8%. Based on HIV test results of male clients and self-reported status from FSWs, an estimated 12.1% of male client-FSW pairs were sero-discordant. These Dawson Rose, Carol; Webel, Allison; Sullivan, Kathleen M.; Cuca, Yvette P.; Wantland, Dean; Johnson, Mallory O.; Brion, John; Portillo, Carmen J.; Corless, Inge B.; Voss, Joachim; Chen, Wei-Ti; Phillips, J. Craig; Tyer-Viola, Lynda; Rivero-Méndez, Marta; Nicholas, Patrice K. Sexual risk behavior and illicit drug use among people living with HIV/AIDS (PLWHA) contribute to poor health and onward transmission of HIV. The aim of this collaborative multi-site nursing research study was to explore the association between self-compassion and risk behaviors in PLWHA. Nurse researchers in Canada, China, Namibia, Puerto Rico, Thailand and the U.S. enrolled 2,182 PLWHA using convenience sampling. Over half of study participants were sexually active in the past three months.... Elías, María Jesús Pérez; Gómez-Ayerbe, Cristina; Elías, Pilar Pérez; Muriel, Alfonso; de Santiago, Alberto Diaz; Martinez-Colubi, María; Moreno, Ana; Santos, Cristina; Polo, Lidia; Barea, Rafa; Robledillo, Gema; Uranga, Almudena; Espín, Agustina Cano; Quereda, Carmen; Dronda, Fernando; Casado, Jose Luis; Moreno, Santiago The aim of our study was to develop a Spanish-structured HIV risk of exposure and indicator conditions (RE&IC) questionnaire. People attending to an emergency room or to a primary clinical care center were offered to participate in a prospective, 1 arm, open label study, in which all enrolled patients filled out our developed questionnaire and were HIV tested. Questionnaire accuracy, feasibility, and reliability were evaluated.Valid paired 5329 HIV RE&IC questionnaire and rapid HIV tests were performed, 69.3% in the primary clinical care center, 49.6% women, median age 37 years old, 74.9% Spaniards, 20.1% Latin-Americans. Confirmed hidden HIV infection was detected in 4.1%, while HIV RE&IC questionnaire was positive in 51.2%. HIV RE&IC questionnaire sensitivity was 100% to predict HIV infection, with a 100% negative predictive value. When considered separately, RE or IC items sensitivity decreases to 86.4% or 91%, and similarly their negative predictive value to 99.9% for both of them. The majority of people studied, 90.8% self-completed HIV RE&IC questionnaire. Median time to complete was 3 minutes. Overall HIV RE&IC questionnaire test-retest Kappa agreement was 0.82 (almost perfect), likewise for IC items 0.89, while for RE items was lower 0.78 (substantial).A feasible and reliable Spanish HIV RE&IC self questionnaire accurately discriminated all non-HIV-infected people without missing any HIV diagnoses, in a low prevalence HIV infection area. The best accuracy and reliability were obtained when combining HIV RE&IC items. Folch, Cinta; Casabona, Jordi; Espelt, Albert; Majó, Xavier; Meroño, Mercè; Gonzalez, Victoria; Brugal, Maria Teresa To describe gender differences in injection and sexual risks behaviours, and human immunodeficiency virus (HIV) and hepatitis C (HCV) prevalence among injecting drug users (IDU) in Catalonia, Spain. Cross-sectional studies in 2008-2009 (n=748) and 2010-2011 (n=597) in the network of harm reduction centres. Face to face interviews were conducted and oral fluid samples were collected to estimate HIV/HCV prevalence. Female were more likely than male IDU to have had a steady sexual partner (68.2% versus 44.9%), to have had an IDU steady sexual partner (46.6% versus 15.1%) and to have exchanged sex for money or drugs in the last 6 months (25.5% versus 2.3%). There were no gender differences in injecting risk behaviours. HIV prevalence was 38.7% (91/235) in women and 31.5% (347/1103) in men (p=0.031). HIV prevalence among female IDU who reported having exchange sex for money or drugs was 53.3% (32/60). The prevalence of HCV was 67.4% (159/236) and 73.6% (810/1101) in female and male IDU, respectively (p=0.053). After adjustment by immigrant status, age and years of injection, differences among HIV/HCV prevalence by gender were not significant. This study demonstrated differences in sexual risk behaviours between male and female IDU, but failed to find gender differences in injecting risk behaviours. Apart from that, the higher prevalence of HIV among women than among men, together with a lower prevalence of HCV, provides evidence that sexual transmission of HIV is important among female IDU. Additional studies are needed to analyze in-depth these specific risk factors for women in order to develop appropriate prevention and health education programs. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved. Rachel M. Zack Full Text Available Premature delivery, a significant cause of child mortality and morbidity worldwide, is particularly prevalent in the developing world. As HIV is highly prevalent in much of sub-Saharan Africa, it is important to determine risk factors for prematurity among HIV-positive pregnancies. The aims of this study were to identify risk factors of preterm (<37 weeks and very preterm (<34 weeks birth among a cohort of 927 HIV positive women living in Dar es Salaam, Tanzania, who enrolled in the Tanzania Vitamin and HIV Infection Trial between 1995 and 1997. Multivariable relative risk regression models were used to determine the association of potential maternal risk factors with premature and very premature delivery. High rates of preterm (24% and very preterm birth (9% were found. Risk factors (adjusted RR (95% CI for preterm birth were mother <20 years (1.46 (1.10, 1.95, maternal illiteracy (1.54 (1.10, 2.16, malaria (1.42 (1.11, 1.81, Entamoeba coli (1.49 (1.04, 2.15, no or low pregnancy weight gain, and HIV disease stage ≥2 (1.41 (1.12, 1.50. Interventions to reduce pregnancies in women under 20, prevent and treat malaria, reduce Entamoeba coli infection, and promote weight gain in pregnant women may have a protective effect on prematurity. Glasman, Laura R; Dickson-Gomez, Julia; Lechuga, Julia; Tarima, Sergey; Bodnar, Gloria; de Mendoza, Lorena Rivas In El Salvador, crack users are at high risk for HIV but they are not targeted by efforts to promote early HIV diagnosis. We evaluated the promise of peer-referral chains with incentives to increase HIV testing and identify undiagnosed HIV infections among networks of crack users in San Salvador. For 14 months, we offered HIV testing in communities with a high prevalence of crack use. For the following 14 months, we promoted chains in which crack users from these communities referred their peers to HIV testing and received a small monetary incentive. We recorded the monthly numbers of HIV testers, and their crack use, sexual risk behaviors and test results. After launching the referral chains, the monthly numbers of HIV testers increased significantly (Z = 6.90, p < .001) and decayed more slowly (Z = 5.93, p < .001), and the total number of crack-using testers increased nearly fourfold. Testers in the peer-referral period reported fewer HIV risk behaviors, but a similar percentage (~5 %) tested HIV positive in both periods. More women than men received an HIV-positive diagnosis throughout the study (χ(2)(1, N = 799) = 4.23, p = .040). Peer-referral chains with incentives can potentially increase HIV testing among networks of crack users while retaining a focus on high-risk individuals. Rasmussen, Line D; Omland, Lars H; Pedersen, Court with the HIV disease and HAART or whether life-style related or genetic factors also increase the risk in this population. To establish whether the increased risk of myocardial infarction in HIV patients partly reflects an increased risk of MI in their families, we estimated the relative risk of MI in parents... The Relationship Between Online Social Network Use, Sexual Risk Behaviors, and HIV Sero-Status Among a Sample of Predominately African American and Latino Men Who have Sex with Men (MSM) Social Media Users. Chiu, ChingChe J; Young, Sean D Social networking technologies have emerged as potential platforms to reach HIV(+) MSM in HIV interventions. This study sought to compare use of online social networking sites (SNSs) and sexual risk behaviors between HIV(+) and HIV(-) individuals among a sample of predominately African American and Latino SNS-using MSM. A total of 112 MSM Facebook users were recruited online and offline and completed an online survey. We performed regression models to assess the association between HIV status, SNS use, and sexual risk behaviors. After adjusting for age, race, and employment status, being HIV positive was significantly associated with a greater number of sexual partners (ARR = 2.84, p = 0.0017) and lower comfort levels of discussing HIV/STI status on SNSs (AOR: 0.23, p = 0.011). Findings suggest that HIV status is associated with sexual risk behaviors and SNS use among SNS-using MSM. We discuss the implications for online HIV prevention. Grillo, Michael; Tran, Bonnie Robin; Tamoufe, Ubald; Djoko, Cyrille F; Saylors, Karen; Woodland, Kelly; Wangmene, L T C; Macera, Caroline Continued surveillance of the HIV epidemic is critical to monitor changes in trends and risk behaviors. A 2005 study in the Cameroonian Armed Forces (CAF) found an HIV prevalence of 11.3% among male and female service members. The purpose of the current study is to determine the 5-year change in the HIV prevalence, estimate the prevalence of syphilis, and examine factors associated with infection in the CAF. Participants were male and female service members 18 years of age or older who were stationed at one of the 10 military garrisons selected for participation. The military garrisons included in this study were proportionally representative of the CAF by geographic region. Military companies and individuals within the selected garrisons were randomly chosen to participate in the study. Demographic and behavioral risk data were collected from September-November 2011 using personal interviews. Blood was collected for HIV and syphilis testing. Of 2,523 participants tested, 6.0% screened positive for HIV [includes 5.3% who screened positive for HIV only and 0.7% who screened positive for both HIV and syphilis], and 3.1% screened positive for syphilis only. Analyses examining risk factors associated with HIV/syphilis infection (i.e., infected with HIV, infected with syphilis, or co-infected with both HIV and syphilis) were restricted to 2,255 men who reported ever having sex. In a multivariate logistic regression model, the odds of testing positive for HIV/syphilis were higher among men who were separated, divorced, or widowed (adjusted odds ratio [AOR]=3.13, 95% confidence interval [CI]: 1.24-7.89), had sex with sex workers (AOR=1.64, 95% CI: 1.19-2.27), and reported a genital sore/ulcer in the past 12 months preceeding the survey (AOR=1.73, 95% CI: 1.05-2.86). Higher HIV knowledge was protective against HIV/syphilis infection (AOR=0.73, 95% CI: 0.54-0.99). While the overall HIV prevalence in this sample of military personnel was lower than previously reported (6 Haley, Danielle F; Wingood, Gina M; Kramer, Michael R; Haardörfer, Regine; Adimora, Adaora A; Rubtsova, Anna; Edmonds, Andrew; Goswami, Neela D; Ludema, Christina; Hickson, DeMarc A; Ramirez, Catalina; Ross, Zev; Bolivar, Hector; Cooper, Hannah L F Neighborhood social and physical factors shape sexual network characteristics in HIV-seronegative adults in the U.S. This multilevel analysis evaluated whether these relationships also exist in a predominantly HIV-seropositive cohort of women. This cross-sectional multilevel analysis included data from 734 women enrolled in the Women's Interagency HIV Study's sites in the U.S. South. Census tract-level contextual data captured socioeconomic disadvantage (e.g., tract poverty), number of alcohol outlets, and number of non-profits in the census tracts where women lived; participant-level data, including perceived neighborhood cohesion, were gathered via survey. We used hierarchical generalized linear models to evaluate relationships between tract characteristics and two outcomes: perceived main sex partner risk level (e.g., partner substance use) and perceived main sex partner non-monogamy. We tested whether these relationships varied by women's HIV status. Greater tract-level socioeconomic disadvantage was associated with greater sex partner risk (OR 1.29, 95% CI 1.06-1.58) among HIV-seropositive women and less partner non-monogamy among HIV-seronegative women (OR 0.69, 95% CI 0.51-0.92). Perceived neighborhood trust and cohesion was associated with lower partner risk (OR 0.83, 95% CI 0.69-1.00) for HIV-seropositive and HIV-seronegative women. The tract-level number of alcohol outlets and non-profits were not associated with partner risk characteristics. Neighborhood characteristics are associated with perceived sex partner risk and non-monogamy among women in the South; these relationships vary by HIV status. Future studies should examine causal relationships and explore the pathways through which neighborhoods influence partner selection and risk characteristics. Nwokoji, Ugboga Adaji; Ajuwon, Ademola J Background The epidemic of HIV continues to grow in Nigeria. Personnel in the military are at increased risk of HIV infection. Although HIV-risk related sexual behavior of Nigerian police officers has been studied, little is known about the sexual behavior of their counterparts in the Navy. This study describes knowledge of AIDS, and HIV-risk sexual behavior of naval personnel in Lagos Nigeria. Methods Four hundred and eighty personnel of the Nigerian Navy completed a 70-item questionnaire in 2002. Group discussion and in-depth interviews of four key informants were also conducted to gain insights into the context of risky sexual behaviors and suggestions for feasible HIV primary prevention interventions. Results The mean age of the respondents was 34 years. Although the overall mean AIDS knowledge score was 7.1 of 10 points, 52.1% of respondents believed that a cure for AIDS was available in Nigeria and that one can get HIV by sharing personal items with an infected person (25.3%). The majority (88.1%) had had lifetime multiple partners ranging from 1–40 with a mean of 5.1; 32.5% of male respondents had had sexual contact with a female sex worker, 19.9% did so during the six months preceding the survey. Forty-one percent of those with sexual contact with a female sex worker did not use a condom during the most recent sexual encounter with these women. Naval personnel who have been transferred abroad reported significantly more risky sexual behaviors than others. Group discussants and key informants believed that sex with multiple partners is a tradition that has persisted in the navy even in the era of AIDS because of the belief that AIDS affects only foreigners, that use of traditional medicine provides protection against HIV infection, and influence of alcohol. Conclusion Many naval personnel report participating in high-risk sexual behavior which may increase their risk of acquiring and spreading HIV. Naval personnel live and interact freely with civilian Ajuwon Ademola J Full Text Available Abstract Background The epidemic of HIV continues to grow in Nigeria. Personnel in the military are at increased risk of HIV infection. Although HIV-risk related sexual behavior of Nigerian police officers has been studied, little is known about the sexual behavior of their counterparts in the Navy. This study describes knowledge of AIDS, and HIV-risk sexual behavior of naval personnel in Lagos Nigeria. Methods Four hundred and eighty personnel of the Nigerian Navy completed a 70-item questionnaire in 2002. Group discussion and in-depth interviews of four key informants were also conducted to gain insights into the context of risky sexual behaviors and suggestions for feasible HIV primary prevention interventions. Results The mean age of the respondents was 34 years. Although the overall mean AIDS knowledge score was 7.1 of 10 points, 52.1% of respondents believed that a cure for AIDS was available in Nigeria and that one can get HIV by sharing personal items with an infected person (25.3%. The majority (88.1% had had lifetime multiple partners ranging from 1–40 with a mean of 5.1; 32.5% of male respondents had had sexual contact with a female sex worker, 19.9% did so during the six months preceding the survey. Forty-one percent of those with sexual contact with a female sex worker did not use a condom during the most recent sexual encounter with these women. Naval personnel who have been transferred abroad reported significantly more risky sexual behaviors than others. Group discussants and key informants believed that sex with multiple partners is a tradition that has persisted in the navy even in the era of AIDS because of the belief that AIDS affects only foreigners, that use of traditional medicine provides protection against HIV infection, and influence of alcohol. Conclusion Many naval personnel report participating in high-risk sexual behavior which may increase their risk of acquiring and spreading HIV. Naval personnel live and Full Text Available BACKGROUND: Human Immunodeficiency Virus (HIV status disclosure has been shown to provide several benefits, both at the individual and societal levels. AIM: To determine risk factors associated with disclosing HIV status among antiretroviral therapy (ART recipients in South Africa. SETTING: A cross-sectional study on risk factors for viremia and drug resistance took place at two outpatient HIV clinics in 2008, at a large hospital located in Soweto, South Africa. METHODS: We conducted a secondary data analysis on socio-economic characteristics and HIV status disclosure to anyone, focusing on gender differences. Descriptive and multivariable logistic regression analyses were performed to model the associations between risk factors and HIV status disclosure. Additionally, descriptive analysis was conducted to describe gender differences of HIV status disclosure to partner, parents, parents in law, partner, child, family, employer, and other. PATIENTS: A total of 883 patients were interviewed. The majority were women (73% with median age of 39 years. RESULTS: Employed patients were less likely to disclose than unemployed (odds ratio (OR 0.36; 95% confidence interval (CI 0.1-1.0; p = 0.05. Women with higher income were more likely to disclose (OR 3.25; 95% CI 0.90-11.7; p = 0.07 than women with lower income, while men with higher income were less likely (OR 0.20; 95% CI 0.02-1.99; p = 0.17 than men with lower income. Men were more likely than women to disclose to their partner (p<0.01, and to partner and family (p<0.01, women were more likely than men to disclose to child and family (p<0.01, to child, family and others (p = 0.01. CONCLUSION: Being employed imposed a risk factor for HIV status disclosure, additionally we found an interaction effect of gender and income on disclosure. Interventions designed to reduce workplace discrimination and gender-sensitive interventions promoting disclosure are strongly recommended. Wall, Kristin M; Kilembe, William; Vwalika, Bellington; Htee Khu, Naw; Brill, Ilene; Chomba, Elwyn; Johnson, Brent A; Haddad, Lisa; Tichacek, Amanda; Allen, Susan To determine the impact of hormonal contraceptive methods on risk of HIV acquisition among HIV-negative women cohabiting with HIV-positive male partners. From 1994-2012, HIV discordant couples recruited from a couples' voluntary HIV counseling and testing center in Lusaka, Zambia were followed longitudinally. HIV-negative partners were tested quarterly. This analysis is restricted to couples in which the man was HIV-positive and the woman was HIV-negative at enrollment and the man was not on antiretroviral treatment. Multivariate Cox models evaluated associations between time-varying contraceptive methods and HIV acquisition among women. Sensitivity analyses explored exposure misclassification and time-varying confounder mediation. Among 1393 couples, 252 incident infections occurred in women over 2842 couple-years (8.9 infections per 100 couple-years; 95% CI, 7.8-10.0). Multivariate Cox models indicated that neither injectable [adjusted hazard ratio (aHR)=1.2; 95% CI, 0.8-1.7], oral contraceptive pill (OCP, aHR=1.3; 95% CI, 0.9-1.8), or implant (aHR=1.1; 95% CI, 0.5-2.2) use was significantly associated with HIV acquisition relative to non-hormonal contraception controlling for woman's age, literacy and time-varying measures of genital ulceration/inflammation. This remained true when only looking at the subset of infections acquired from the spouse (82% of infections) and additionally controlling for baseline HIV viral load of the male partner, pregnancy status, and time-varying measures of sperm on a vaginal swab wet prep and self-reported unprotected sex. OCP and injectable users reported more unprotected sex (pcontraception and HIV acquisition risk in women. Condom use and reinforced condom counseling should always be recommended for HIV discordant couples. HIV testing of sex partners together is critical to establish HIV risk, ascertain couple fertility intentions and counsel appropriately. These findings add to a controversial literature and uniquely address May 27, 2013 ... surge and the sexual exposures put adolescent at risk of. HIV, other STI and unwanted pregnancy. This study was ... spector of Education, Jos North Local Government. Area, and the various schools' Principals gave approval ..... Knowledge, Risk Perception of AIDS and reported sexual be- haviour among ... Magadi, Monica A The link between HIV infection and poverty in sub-Saharan Africa (SSA) is rather complex and findings from previous studies remain inconsistent. While some argue that poverty increases vulnerability, existing empirical evidence largely support the view that wealthier men and women have higher prevalence of HIV. In this paper, we examine the association between HIV infection and urban poverty in SSA, paying particular attention to differences in risk factors of HIV infection between the urban poor and non-poor. The study is based on secondary analysis of data from the Demographic and Health Surveys from 20 countries in SSA, conducted during 2003-2008. We apply multilevel logistic regression models, allowing the urban poverty risk factor to vary across countries to establish the extent to which the observed patterns are generalizable across countries in the SSA region. The results reveal that the urban poor in SSA have significantly higher odds of HIV infection than their urban non-poor counterparts, despite poverty being associated with a significantly lower risk among rural residents. Furthermore, the gender disparity in HIV infection (i.e. the disproportionate higher risk among women) is amplified among the urban poor. The paper confirms that the public health consequence of urban poverty that has been well documented in previous studies with respect to maternal and child health outcomes does apply to the risk of HIV infection. The positive association between household wealth and HIV prevalence observed in previous studies largely reflects the situation in the rural areas where the majority of the SSA populations reside. Zack, Rachel M.; Golan, Jenna; Aboud, Said; Msamanga, Gernard; Spiegelman, Donna; Fawzi, Wafaie Premature delivery, a significant cause of child mortality and morbidity worldwide, is particularly prevalent in the developing world. As HIV is highly prevalent in much of sub-Saharan Africa, it is important to determine risk factors for prematurity among HIV-positive pregnancies. The aims of this study were to identify risk factors of preterm ( Friedman, Samuel R.; Bolyard, Melissa; Khan, Maria; Maslow, Carey; Sandoval, Milagros; Mateu-Gelabert, Pedro; Krauss, Beatrice; Aral, Sevgi O. Objectives To describe: a. the prevalence and individual and network characteristics of group sex events (GSE) and GSE attendees; and b. HIV/STI discordance among respondents who said they went to a GSE together. Methods and Design In a sociometric network study of risk partners (defined as sexual partners, persons with whom respondents attended a GSE, or drug-injection partners) in Brooklyn, NY, we recruited a high-risk sample of 465 adults. Respondents reported on GSE attendance, the characteristics of GSEs, and their own and others’ behaviors at GSEs. Sera and urines were collected and STI prevalence was assayed. Results Of the 465 participants, 36% had attended a GSE in the last year, 26% had sex during the most recent of these GSEs, and 13% had unprotected sex there. Certain subgroups (hard drug users, men who have sex with men, women who have sex with women, and sex workers) were more likely to attend and more likely to engage in risk behaviors at these events. Among 90 GSE dyads in which at least one partner named the other as someone with whom they attended a GSE in the previous three months, STI/HIV discordance was common (HSV-2: 45% of dyads, HIV: 12% of dyads, Chlamydia: 21% of dyads). Many GSEs had 10 or more participants, and multiple partnerships at GSEs were common. High attendance rates at GSEs among members of large networks may increase community vulnerability to STI/HIV, particularly since network data show that almost all members of a large sociometric risk network either had sex with a GSE attendee or had sex with someone who had sex with a GSE attended. Conclusions Self-reported GSE attendance and participation was common among this high-risk sample. STI/HIV discordance among GSE attendees was high, highlighting the potential transmission risk associated with GSEs. Research on sexual behaviors should incorporate measures of GSE behaviors as standard research protocol. Interventions should be developed to reduce transmission at GSEs. PMID Weine, Stevan; Golobof, Alexandra; Bahromov, Mahbat; Kashuba, Adrianna; Kalandarov, Tohir; Jonbekov, Jonbek; Loue, Sana This study aimed to build formative knowledge regarding HIV risks in female migrant sex workers in Moscow, focusing on gender and power. This was a collaborative ethnographic study, informed by the theory of gender and power, in which researchers conducted minimally structured interviews with 24 female sex workers who were migrants to Moscow and who provided sexual services to male migrant laborers. Overall, the female migrant sex workers engaged in HIV risk behaviors and practiced inadequate HIV protection with their clients. These behaviors were shaped by gender and power factors in the realms of labor, behavior, and cathexis. In the labor realm, because some female migrants were unable to earn enough money to support their families, they were pushed or pulled into sex work providing service to male migrants. In the behavior realm, many female migrant sex workers were intimidated by their male clients, feared violence, and lacked access to women's health care and prevention. In the cathexis realm, many had a sense of shame, social isolation, emotional distress, and lacked basic HIV knowledge and prevention skills. To prevent HIV transmission requires addressing the gender and power factors that shape HIV/AIDS risks among female migrant sex workers through multilevel intervention strategies. Full Text Available Background: Condomless anal intercourse (CLAI has long been recognised as the primary mode of sexual transmission of HIV in gay and other men who have sex with men (MSM. A variety of measures of CLAI have been commonly used in behavioural surveillance for HIV risk and to forecast trends in HIV infection. However, gay and other MSM’s sexual practices changed as the understanding of disease and treatment options advance. In the present paper, we argue that summary measures such as any CLAI do not accurately measure HIV sexual risk behaviour. Methods: Participants were 1,427 HIV-negative men from the Health in Men cohort study run from 2001 to 2007 in Sydney, Australia, with six-monthly interviews. At each interview, detailed quantitative data on the number of episodes of insertive and receptive CLAI in the last six months were collected, separated by partner type (regular vs. casual and partners’ HIV status (negative, positive, and HIV status unknown.Results: A total of 228,064 episodes of CLAI were reported during the study period with a mean of 44 episodes per year per participant (median: 14. The great majority of CLAI episodes were with a regular partner (92.6%, most of them with HIV-negative regular partners (84.8%. Participants were more likely to engage in insertive CLAI with casual than with regular partners (66.7% vs. 55.3% of all acts of CLAI with each partner type, p<0.001. Men were more likely to report CLAI in the receptive position with HIV-negative and HIV status unknown partners than with HIV-positive partners (p<0.001 for both regular and casual partners. Conclusion: Gay and other MSM engaging in CLAI demonstrate clear patterns of HIV risk reduction behaviour. As HIV prevention enters the era of antiretroviral-based biomedical approach, using all forms of CLAI indiscriminately as a measure of HIV behavioural risk is not helpful in understanding the current drivers of HIV transmission in the community. Nara Chartuni Pereira Teixeira Full Text Available OBJECTIVES: To evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN among HIV-infected women. METHODS: Cross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors. RESULTS: CIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1. Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5-10.1, with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2-3.5, and with age < 34 years old (OR 1.5, 95% CI 1.0-2.4. HIV viral load and antiretroviral use were not independent risk factors for CIN. CONCLUSIONS: Severity of immunosupression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women. Ganle, John Kuumuori Among the youth in some parts of sub-Saharan Africa, a paradoxical mix of adequate knowledge of HIV/AIDS and high-risk behavior characterizes their daily lives. Based on original qualitative research in Ghana, I explore in this article the ways in which the social construction of masculinity influences youth's responses to behavior change HIV/AIDS prevention interventions. Findings show that although awareness of the HIV/AIDS epidemic and the risks of infection is very high among the youth, a combination of hegemonic masculinity and perceptions of personal invulnerability acts to undermine the processes of young people's HIV/AIDS risk construction and appropriate behavioral change. I argue that if HIV/AIDS prevention is to be effective and sustained, school- and community-based initiatives should be developed to provide supportive social spaces in which the construction of masculinity, the identity of young men and women as gendered persons, and perceptions of their vulnerability to HIV/AIDS infection are challenged. © The Author(s) 2015. Saffier, Igor Pedrosa; Kawa, Hélia; Harling, Guy Despite young people being a key population for HIV prevention, the HIV epidemic amongst young Brazilians is perceived to be growing. We therefore reviewed all published literature on HIV prevalence and risk factors for HIV infection amongst 10-25 year olds in Brazil. We searched Embase, LILACS, Proquest, PsycINFO, PubMed, Scopus and Web of Science for studies published up to March 2017 and analyzed reference lists of relevant studies. We included published studies from any time in the HIV epidemic which provided estimates specific to ages 10-25 (or some subset of this age range) for Brazilians on either: (a) HIV prevalence or incidence; or (b) the association between HIV and socio-demographic or behavioral risk factors. Forty eight publications met the inclusion criteria: 44 cross-sectional, two case-control, two cohort. Four studies analysed national data. Forty seven studies provided HIV prevalence estimates, largely for six population subgroups: Counselling and Testing Center attendees; blood donors; pregnant women; institutional individuals; men-who-have-sex-with-men (MSM) and female sex workers (FSW); four provided HIV incidence estimates. Twelve studies showed HIV status to be associated with a wide range of risk factors, including age, sexual and reproductive history, infection history, substance use, geography, marital status, mental health and socioeconomic status. Few published studies have examined HIV amongst young people in Brazil, and those published have been largely cross-sectional and focused on traditional risk groups and the south of the country. Despite these limitations, the literature shows raised HIV prevalence amongst MSM and FSW, as well as amongst those using drugs. Time trends are harder to identify, although rates appear to be falling for pregnant women, possibly reversing an earlier de-masculinization of the epidemic. Improved surveillance of HIV incidence, prevalence and risk factors is a key component of efforts to eliminate HIV in Chen, Yea-Hung; Raymond, Henry Fisher HIV prevention plans for men who have sex with men (MSM) are often multifaceted. They involve reduction of sexual risk behaviors, such as condomless intercourse, but also often include pharmaceutical approaches, such as early treatment of HIV-infected individuals with antiretroviral therapy (ART). Effectiveness is possibly threatened by individual-level factors, such as depression. In this study of 322 San Francisco MSM (240 HIV-uninfected individuals and 82 HIV-infected individuals, according to self-report), we examine associations between depressive syndromes and HIV risk behaviors (sexual risk behaviors and ART non-adherence). Our study failed to find evidence that depressive syndromes lead to increases in ART non-adherence (risk difference, RD: 27.9; 95% confidence interval, CI: -3.5, 59.3). However, the study does suggest an association between depressive syndromes and concurrence of non-adherence and potentially HIV-discordant condomless receptive anal intercourse (RD: 36.0; 95% CI: 5.2, 66.8). Among HIV-uninfected MSM, our study suggests negative associations between depressive syndromes and sexual risk behaviors. We recommend screening and treatment of depression among HIV-infected MSM. Jobson, Geoffrey; Tucker, Andrew; de Swardt, Glenn; Rebe, Kevin; Struthers, Helen; McIntyre, James; Peters, Remco Gender identity plays a potentially important role contributing to HIV risk among MSM in South Africa. Where studies have included a focus on gender identity, MSM reporting gender non-conformity have been found to have a higher risk of being HIV positive than other MSM. This article examines HIV risk among gender non-conforming MSM in a sample of 316 MSM in Cape Town, South Africa. Reporting gender non-conformity was associated with higher HIV prevalence and increased HIV risk behaviour. Gender non-conformity was also associated with a higher likelihood of being unemployed and reporting low household incomes. These findings highlight the importance of gender-identity as a factor affecting access to HIV treatment, care, and prevention in South Africa and this is an issue that needs to be addressed in interventions targeting MSM populations. Drawing on long-term research with young adults in Lesotho, I examine how social environment factors contribute to HIV risk. During preliminary ethnographic analysis, I developed novel scales to measure social control, adoption of modernity, and HIV knowledge. In survey research, I examined the effects of individual ... Longinetti, Elisa; Santacatterina, Michele; El-Khatib, Ziad Human Immunodeficiency Virus (HIV) status disclosure has been shown to provide several benefits, both at the individual and societal levels. To determine risk factors associated with disclosing HIV status among antiretroviral therapy (ART) recipients in South Africa. A cross-sectional study on risk factors for viremia and drug resistance took place at two outpatient HIV clinics in 2008, at a large hospital located in Soweto, South Africa. We conducted a secondary data analysis on socio-economic characteristics and HIV status disclosure to anyone, focusing on gender differences. Descriptive and multivariable logistic regression analyses were performed to model the associations between risk factors and HIV status disclosure. Additionally, descriptive analysis was conducted to describe gender differences of HIV status disclosure to partner, parents, parents in law, partner, child, family, employer, and other. A total of 883 patients were interviewed. The majority were women (73%) with median age of 39 years. Employed patients were less likely to disclose than unemployed (odds ratio (OR) 0.36; 95% confidence interval (CI) 0.1-1.0; p = 0.05)). Women with higher income were more likely to disclose (OR 3.25; 95% CI 0.90-11.7; p = 0.07) than women with lower income, while men with higher income were less likely (OR 0.20; 95% CI 0.02-1.99; p = 0.17) than men with lower income. Men were more likely than women to disclose to their partner (pwomen were more likely than men to disclose to child and family (pgender and income on disclosure. Interventions designed to reduce workplace discrimination and gender-sensitive interventions promoting disclosure are strongly recommended. Pinedo, Miguel; Burgos, José Luis; Robertson, Angela M; Vera, Alicia; Lozada, Remedios; Ojeda, Victoria D Deported injection drug users (IDUs) in Mexico may be vulnerable to HIV infection following expulsion from the USA. We examined factors associated with HIV risk perception among a sample of deportees in Tijuana. From January to April 2010, 313 male IDUs who reported ever being deported from the USA completed a questionnaire. Overall, 35% (N=110) of deportees perceived HIV risk. In multivariate logistic regression analyses, factors independently associated with HIV risk perception included ever having a steady female partner in Tijuana post-deportation (adjusted odds ratio [AOR]: 2.26; 95% confidence interval [CI]: 1.01-5.07) and years spent in a US prison (AOR: 1.29 per year; 95% CI: 1.13-1.48). Conversely, years of drug injection use (AOR: 0.95 per year; 95% CI: 0.91-0.99), ever witnessing family members use drugs prior to first migration trip (AOR: 0.24; 95% CI: 0.09-0.65), years of residence in the USA (AOR: 0.91 per year; 95% CI: 0.84-0.98) and being a Tijuana native (AOR: 0.40; 95% CI: 0.16-0.99) were negatively associated with HIV risk perception. US-Mexico border cities that receive deported migrants should target HIV prevention interventions to specific subgroups, including drug-using male deportees. Interventions should consider migrant's time in the USA, the role of their social networks, and reducing missed opportunities for HIV testing/education. Full Text Available AIM: To analyze alcohol use, clinical data and laboratory parameters that may affect FIB-4, an index for measuring liver fibrosis, in HCV-monoinfected and HCV/HIV-coinfected drug users. PATIENTS AND METHODS: Patients admitted for substance abuse treatment between 1994 and 2006 were studied. Socio-demographic data, alcohol and drug use characteristics and clinical variables were obtained through hospital records. Blood samples for biochemistry, liver function tests, CD4 cell count, and serology of HIV and HCV infection were collected at admission. Multivariate linear regression was used to analyze the predictors of FIB-4 increase. RESULTS: A total of 472 (83% M, 17% F patients were eligible. The median age at admission was 31 years (Interquartile range (IQR 27-35 years, and the median duration of drug use was 10 years (IQR 5.5-15 years. Unhealthy drinking (>50 grams/day was reported in 32% of the patients. The FIB-4 scores were significantly greater in the HCV/HIV-coinfected patients (1.14, IQR 0.76-1.87 than in the HCV-monoinfected patients (0.75, IQR 0.56-1.11 (p<0.001. In the multivariate analysis, unhealthy drinking (p = 0.034, lower total cholesterol (p = 0.042, serum albumin (p<0.001, higher GGT (p<0.001 and a longer duration of addiction (p = 0.005 were independently associated with higher FIB-4 scores in the HCV-monoinfected drug users. The effect of unhealthy drinking on FIB-4 scores disappeared in the HCV/HIV-coinfected patients, whereas lower serum albumin (p<0.001, a lower CD4 cell count (p = 0.006, higher total bilirubin (p<0.001 and a longer drug addiction duration (p<0.001 were significantly associated with higher FIB-4 values. CONCLUSIONS: Unhealthy alcohol use in the HCV-monoinfected patients and HIV-related immunodeficiency in the HCV/HIV-coinfected patients are important risk factors associated with liver fibrosis in the respective populations. Platt, Lucy; Jolley, Emma; Rhodes, Tim; Hope, Vivian; Latypov, Alisher; Reynolds, Lucy; Wilson, David Objectives We reviewed the epidemiology of HIV and selected sexually transmitted infections (STIs) among female sex workers (FSWs) in WHO-defined Europe. There were three objectives: (1) to assess the prevalence of HIV and STIs (chlamydia, syphilis and gonorrhoea); (2) to describe structural and individual-level risk factors associated with prevalence and (3) to examine the relationship between structural-level factors and national estimates of HIV prevalence among FSWs. Design A systematic search of published and unpublished literature measuring HIV/STIs and risk factors among FSWs, identified through electronic databases published since 2005. ‘Best’ estimates of HIV prevalence were calculated from the systematic review to provide national level estimates of HIV. Associations between HIV prevalence and selected structural-level indicators were assessed using linear regression models. Studies reviewed Of the 1993 papers identified in the search, 73 peer-reviewed and grey literature documents were identified as meeting our criteria of which 63 papers provided unique estimates of HIV and STI prevalence and nine reported multivariate risk factors for HIV/STI among FSWs. Results HIV in Europe remains low among FSWs who do not inject drugs (HIV, including lack of access to services and working on the street. Linear regression models showed HIV among FSWs to link with injecting drug use and imprisonment. Conclusions Findings show that HIV prevention interventions should be nested inside strategies that address the social welfare of sex workers, highlighting in turn the need to target the social determinants of health and inequality, including regarding access to services, experience of violence and migration. Future epidemiological and intervention studies of HIV among vulnerable populations need to better systematically delineate how microenvironmental and macroenvironmental factors combine to increase or reduce HIV/STI risk. PMID:23883879 van den Hof, S; Tursynbayeva, A; Abildaev, T; Adenov, M; Pak, S; Bekembayeva, G; Ismailov, S Kazakhstan is a country with a low HIV/AIDS (human immunodeficiency virus/acquired immune-deficiency syndrome) burden, but a high prevalence of multidrug-resistant tuberculosis (MDR-TB). We describe the epidemiology of multidrug resistance and HIV among TB patients, using the 2007-2011 national electronic TB register. HIV test results were available for 97.2% of TB patients. HIV prevalence among TB patients increased from 0.6% in 2007 to 1.5% in 2011. Overall, 41.6% of patients had a positive smear at diagnosis, 38.6% a positive culture and 51.7% either a positive smear or culture. Drug susceptibility testing (DST) results were available for 92.7% of culture-positive cases. Socio-economic factors independently associated with both HIV and MDR-TB were urban residency, drug use, homelessness and a history of incarceration. In adjusted analysis, HIV positivity was not associated with MDR-TB (OR 1.0, 95%CI 0.86-1.2). Overall, among TB patients with DST and HIV test results available, 65.0% were positive for neither HIV nor MDR-TB, 33.5% only for MDR-TB, 0.9% only for HIV and 0.6% for both HIV and MDR-TB. Among injection drug users, 12.5% were positive for HIV and MDR-TB. We showed increasing HIV prevalence among TB patients in Kazakhstan. HIV was not an independent risk factor for MDR-TB, but risk factors were largely overlapping and we did identify subgroups at particular risk of HIV-MDR-TB co-infection, notably drug users. Enhanced efforts are necessary to provide care to these socially vulnerable populations. German, Danielle; Latkin, Carl A. Boredom is closely aligned with depression, but is understood to be conceptually distinct. Little is known about boredom among active drug users and the potential association with depression and HIV risk. Current IDUs (n=845) completed a baseline behavioral survey including socio-demographic characteristics, self-reported boredom, depressive symptoms (CESD score), and HIV risk behaviors. One-third of the sample reported high boredom in the past week. In multivariate analysis, those who reported boredom were less likely to be older, African-American, have a main partner, and to be employed at least part-time. Controlling for covariates, those with high boredom were almost five times as likely to report high depressive symptoms. Co-occurrence of boredom and depressive symptoms (28%) was strongly and independently associated with a range of injection risk behaviors and sex exchange. This study demonstrates the need for more thorough understanding of mental health and HIV risk among urban drug users. PMID:22760741 Fernandes, Fernanda R P; Mousquer, Gina J; Castro, Lisie S; Puga, Marco A; Tanaka, Tayana S O; Rezende, Grazielli R; Pinto, Clarice S; Bandeira, Larissa M; Martins, Regina M B; Francisco, Roberta B L; Teles, Sheila A; Motta-Castro, Ana R C Female sex workers (FSWs) are considered a high-risk group for human immunodeficiency virus (HIV) infection due to their social vulnerability and factors associated with their work. We estimated the prevalence of HIV, and identified viral subtypes and risk factors among FSWs. A cross-sectional study using respondent-driven sampling (RDS) method was conducted among 402 FSWs in Campo Grande city, Brazil, from 2009 to 2011. Participants were interviewed using a standardized questionnaire about sociodemograpic characteristics and risk behavior. Blood samples were collected for serological testing of HIV. Of the 402 FSWs, median age and age of initiating sex work were 25 years (Interquartile range [IQR]: 9) and 20 years (IQR: 6), respectively. The majority reported use of alcohol (88.5%), had 5-9 years (median: 9; IQR: 3) of schooling (54.5%), 68.6% had tattoos/body piercings, and 45.1% had more than seven clients per week (median: 7; IQR: 10). Only 32.9% of FSW reported using a condom with nonpaying partners in the last sexual contact. Prevalence of HIV infection was 1.0% (95% CI: 0.1-2.6%). Genotyping for HIV-1 performed on three samples detected subtypes B, C, and F1. Sex work in the Midwestern region of Brazil is characterized by reduced education, large numbers of clients per week, and inconsistent condom use, mainly with nonpaying partners. Although prevalence of HIV infection is currently low, elevated levels of high-risk sexual behavior confirm a need to implement prevention measures. Specific interventions targeting FSWs must emphasize the risk associated with both clients and nonpaying partners while providing knowledge about HIV prevention. Frew, Paula M; Parker, Kimberly; Vo, Linda; Haley, Danielle; O'Leary, Ann; Diallo, Dazon Dixon; Golin, Carol E; Kuo, Irene; Soto-Torres, Lydia; Wang, Jing; Adimora, Adaora A; Randall, Laura A; Del Rio, Carlos; Hodder, Sally We sought to understand the multilevel syndemic factors that are concurrently contributing to the HIV epidemic among women living in the US. We specifically examined community, network, dyadic, and individual factors to explain HIV vulnerability within a socioecological framework. We gathered qualitative data (120 interviews and 31 focus groups) from a subset of women ages 18-44 years (N = 2,099) enrolled in the HPTN 064 HIV seroincidence estimation study across 10 US communities. We analyzed data from 4 diverse locations: Atlanta, New York City (the Bronx), Raleigh, and Washington, DC. Data were thematically coded using grounded theory methodology. Intercoder reliability was assessed to evaluate consistency of team-based coding practices. The following themes were identified at 4 levels including 1) exosystem (community): poverty prevalence, discrimination, gender imbalances, community violence, and housing challenges; 2) mesosystem (network): organizational social support and sexual concurrency; 3) microsystem (dyadic): sex exchange, interpersonal social support, intimate partner violence; and 4) individual: HIV/STI awareness, risk taking, and substance use. A strong theme emerged with over 80 % of responses linked to the fundamental role of financial insecurity underlying risk-taking behavioral pathways. Multilevel syndemic factors contribute to women's vulnerability to HIV in the US. Financial insecurity is a predominant theme, suggesting the need for tailored programming for women to reduce HIV risk. Clinicaltrials.gov, NCT00995176. Naar-King, Sylvie; Wang, Bo; Panthong, Apirudee; Bunupuradah, Torsak; Parsons, Jeffrey T.; Phonphithak, Supalak; Koken, Juline A.; Saengcharnchai, Pichai; Phanuphak, Praphan Healthy Choices, a four-session motivational interviewing-based intervention, reduces risk behaviors among US youth living with HIV (YLWH). We randomized 110 Thai YLWH (16–25 years) to receive either Healthy Choices or time-matched health education (Control) over 12 weeks. Risk behaviors were assessed at baseline, 1, and 6 months post-session. The pilot study was not powered for between-group differences; there were no statistical differences in sexual risks, alcohol use, and antiretroviral adherence between the two groups at any visit. In within-group analyses, Healthy Choices group demonstrated decreases in the proportion of HIV-negative partners (20 vs 8.2 %, P = 0.03) and HIV sexual risk scores (4.3 vs 3.3, P = 0.04), and increased trends in the proportion of protected sex (57 vs 76.3 %, P = 0.07) from baseline to 1 month post-session. These changes were not sustained 6 months later. No changes were observed in Control group. Healthy Choices has potential to improve sexual risks among Thai YLWH. PMID:23325376 Full Text Available We examined whether knowledge of the HIV-protective benefits of male circumcision (MC led to risk compensating behavior in a traditionally circumcising population in South Africa. We extend the current literature by examining risk compensation among women, which has hitherto been unexplored.We used data on Xhosa men and women from the 2009 Cape Area Panel Study. Respondents were asked if they had heard that MC reduces a man's risk of contracting HIV, about their perceived risk of contracting HIV, and condom use. For each gender group we assessed whether risk perception and condom use differed by knowledge of the protective benefits of MC using bivariate and then multivariate models controlling for demographic characteristics, HIV knowledge/beliefs, and previous sexual behaviors. In a further check for confounding, we used data from the 2005 wave to assess whether individuals who would eventually become informed about the protective benefits of circumcision were already different in terms of HIV risk perception and condom use.34% of men (n=453 and 27% of women (n=690 had heard that circumcision reduces a man's risk of HIV infection. Informed men perceived slightly higher risk of contracting HIV and were more likely to use condoms at last sex (p<0.10. Informed women perceived lower HIV risk (p<0.05, were less likely to use condoms both at last sex (p<0.10 and more generally (p<0.01, and more likely to forego condoms with partners of positive or unknown serostatus (p<0.01. The results were robust to covariate adjustment, excluding people living with HIV, and accounting for risk perceptions and condom use in 2005.We find evidence consistent with risk compensation among women but not men. Further attention should be paid to the role of new information regarding MC, and drivers of HIV risk more broadly, in modulating sexual behavior among women. Nguyen, Tri; Stewart, Donald Edwin; Lee, Chiao Tzu Patricia; Dang, Thi Nhu Hang Female sex workers (FSWs) are at heightened risk of HIV infection. This research aims to determine the prevalence of HIV and relevant risk factors and related behavior among FSWs in Ba Ria - Vung Tau, a southeast province of Vietnam. 420 FSWs were interviewed using a structured questionnaire and biological samples tested for HIV. 2.6 % were found to be HIV positive. HIV infection was significantly higher in FSWs who had low income (≤AUD 200 per month), have had anal sex, have had sex with injecting drug users, and had a low level of HIV/AIDS-related knowledge. Improved employment opportunities and income are important to reduce the pressure for young women to engage in sex work for income purposes, but in public health terms, existing HIV treatment, prevention and intervention programs needs better targeting and improvements to reduce the risk of HIV infection. Diouf, Adama; Idohou Dossou, Nicole; Wade, Salimata; Gartner, Agnes; Sanon, Dominique Alexis; Bluck, Les; Wright, Antony Measurements of body composition are crucial in identifying HIV-infected patients at risk of malnutrition. No information is available on the validity of indirect body composition methods in African HIV-infected outpatients. Our aim was to test the validity of fifteen published equations, developed in whites, African-Americans and/or Africans who were or not HIV-infected, for predicting total body water (TBW) from bioelectrical impedance analysis (BIA) in HIV-infected patients. The second aim was to develop specific predictive equations. Thirty-four HIV-infected patients without antiretroviral treatment and oedema at the beginning of the study (age 39 (SD 7) years, BMI 18.7 (SD 3.7) kg/m2, TBW 30.4 (SD 7.2 kg) were measured at inclusion then 3 and 6 months later. In the resulting eighty-eight measurements, we compared TBW values predicted from BIA to those measured by 2H dilution. Range of bias values was 0.1-4.3, and errors showed acceptable values (2.2-3.4 kg) for fourteen equations and a high value (10.4) for one equation. Two equations developed in non-HIV-infected subjects showed non-significant bias and could be used in African HIV-infected patients. In the other cases, poor agreement indicated a lack of validity. Specific equations developed from our sample showed a higher precision of TBW prediction when using resistance at 1000kHz (1.7kg) than at 50kHz (2.3kg), this latter precision being similar to that of the valid published equations (2.3 and 2.8kg). The valid published or developed predictive equations should be cross-validated in large independent samples of African HIV-infected patients. (Authors) Colbers, Angela; Moltó, José; Ivanovic, Jelena; Kabeya, Kabamba; Hawkins, David; Gingelmaier, Andrea; Taylor, Graham; Weizsäcker, Katharina; Sadiq, S Tariq; Van der Ende, Marchina; Giaquinto, Carlo; Burger, David To describe the pharmacokinetics of darunavir in pregnant HIV-infected women in the third trimester and post-partum. This was a non-randomized, open-label, multicentre, Phase IV study in HIV-infected pregnant women recruited from HIV treatment centres in Europe. HIV-infected pregnant women treated with darunavir (800/100 mg once daily or 600/100 mg twice daily) as part of their combination ART were included. Pharmacokinetic curves were recorded in the third trimester and post-partum. A cord blood sample and maternal sample were collected. The study is registered at ClinicalTrials.gov under number NCT00825929. Twenty-four women were included in the analysis [darunavir/ritonavir: 600/100 mg twice daily (n=6); 800/100 mg once daily (n=17); and 600/100 mg once daily (n=1)]. Geometric mean ratios of third trimester versus post-partum (90% CI) were 0.78 (0.60-1.00) for total darunavir AUC0-tau after 600/100 mg twice-daily dosing and 0.67 (0.56-0.82) for total darunavir AUC0-tau after 800/100 mg once-daily dosing. The unbound fraction of darunavir was not different during pregnancy (12%) compared with post-partum (10%). The median (range) ratio of darunavir cord blood/maternal blood was 0.13 (0.08-0.35). Viral load close to delivery was HIV-negative and no congenital abnormalities were reported. Darunavir AUC and Cmax were substantially decreased in pregnancy for both darunavir/ritonavir regimens. This decrease in exposure did not result in mother-to-child transmission. For antiretroviral-naive patients, who are adherent, take darunavir with food and are not using concomitant medication reducing darunavir concentrations, 800/100 mg of darunavir/ritonavir once daily is adequate in pregnancy. For all other patients 600/100 mg of darunavir/ritonavir twice daily is recommended during pregnancy. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: email@example.com. Jansen, Klaus; Haastert, Burkhard; Michalik, Claudia; Guignard, Adrienne; Esser, Stefan; Dupke, Stephan; Plettenberg, Andreas; Skaletz-Rorowski, Adriane; Brockmeyer, Norbert H HIV infection is a risk factor for the development of Herpes zoster (HZ) and its complications. Prior to antiretroviral therapy (ART), HZ incidence in HIV-infected individuals ranged from 2.9-5.1/100 person-years. There is limited evidence for the impact of ART on HZ occurrence among HIV-infected adults. We analysed the incidence of, and risk factors for, HZ in a large cohort of German HIV-positive patients. The study population was taken from the German KompNet cohort, a nationwide multicenter HIV cohort study. The study population was defined by age (≥ 18 years), year of first positive HIV diagnosis, CD4 values ± 6 months from HIV diagnosis (t0), and month of HZ diagnosis. Incidences were estimated using a Poisson distribution, and uni- and multivariate Cox proportional Hazard ratio (HR) regression models were fitted to identify risk factors for developing an initial HZ episode. Independent variables were sex, age at HIV diagnosis, route of HIV transmission, ART status, CD4 count before HZ episode, immunosuppressive medication, and mode of data documentation (retrospective or prospective). HZ incidence in the overall study population was 1.2/100 person-years. In a subset of patients for that we were able to examine risk factors the following was observed: We examined 3,757 individuals whose mean age at t0 was 38 years. Of those individuals, 96% were diagnosed with HIV in 1996 or later, with a mean observation time of 5.8 years. HZ episodes (n = 362) were recorded in 326 patients (8.7%), resulting in annual HZ incidences of 1.7/100 person-years overall, and 1.6/100 person-years for initial HZ cases. The main risk factors associated with an initial HZ episode were: not partaking in ART compared with an ART regimen containing a non-nucleoside reverse-transcriptase inhibitor (HR 0.530, p study HZ incidences were lower than in previous studies relating to HIV-positive patients. We showed that ART is an important protective factor for HZ episodes. Huang, Wen; Dong, Yanyan; Chen, Lin; Song, Dandan; Wang, Jun; Tao, Haidong; Zaller, Nickolas; Zhang, Hongbo; Operario, Don Sexual behavior is the dominant mode of HIV transmission in China, and young female migrants are among the populations at highest risk. This article examines how HIV-related risk behaviors among female migrants might vary according to workplace settings. Participants were young female migrants recruited from three workplace settings-factories, restaurants and entertainment venues. In a cross-sectional survey, we assessed 457 participants' sociodemographic characteristics, HIV/AIDS-related knowledge, condom use knowledge, sexual behaviors, condom use behavior and reproductive health factors. Participants working in entertainment venues were significantly more likely than those working in factories and restaurants to report sexual behavior, unprotected sex, multiple pregnancy terminations and sexually transmitted infections (STI). However, participants working in factories and restaurants reported significantly lower levels of HIV/AIDS knowledge, condom use knowledge, condom use self-efficacy and history of HIV/AIDS counseling and testing. Independent correlates of unprotected sex included employment in an entertainment venue, abortion history and sexual self-efficacy. Independent correlates of STI or genitourinary tract infection included employment in an entertainment venue, abortion history, recent migration and recent unprotected sex. These findings indicate a need for sexual and reproductive health interventions prioritizing young female migrants, and call for programs that can be incorporated into different workplace settings. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org. Syvertsen, Jennifer L; Bazzi, Angela Robertson; Martinez, Gustavo; Rangel, M Gudelia; Ulibarri, Monica D; Fergus, Kirkpatrick B; Amaro, Hortensia; Strathdee, Steffanie A We examined correlates of love and trust among female sex workers and their noncommercial male partners along the Mexico-US border. From 2011 to 2012, 322 partners in Tijuana and Ciudad Juárez, Mexico, completed assessments of love and trust. Cross-sectional dyadic regression analyses identified associations of relationship characteristics and HIV risk behaviors with love and trust. Within 161 couples, love and trust scores were moderately high (median 70/95 and 29/40 points, respectively) and correlated with relationship satisfaction. In regression analyses of HIV risk factors, men and women who used methamphetamine reported lower love scores, whereas women who used heroin reported slightly higher love. In an alternate model, men with concurrent sexual partners had lower love scores. For both partners, relationship conflict was associated with lower trust. Love and trust are associated with relationship quality, sexual risk, and drug use patterns that shape intimate partners' HIV risk. HIV interventions should consider the emotional quality of sex workers' intimate relationships. Setiawan, I Made; Patten, Jane H We report on selected findings of a qualitative social network study investigating STI/HIV-related risk among migrant fishermen based at one of Indonesia's major fishing ports in Bali. Their activities between fishing trips include drinking parties, watching pornographic videos, and visiting brothels, while condom use is rare. While on board, they plan and anticipate these activities and many insert penile implants. These fishermen run a high personal risk of contracting STI/HIV, and, with their circular migration patterns among Indonesian and foreign ports such as Thailand and South Africa, and with visits back to their rural hometowns and wives or girlfriends in Java, there is a serious risk of disease transmission to the general population. This paper argues that the role that social interactions play in HIV/AIDS-related risks should be considered as important as (if not more important than) individual knowledge, attitudes, and practices in the design of effective STI/HIV prevention programs. Barry, Danielle; Weinstock, Jeremiah; Petry, Nancy M. Objective To identify ethnic differences in HIV risk behaviors among cocaine using women receiving methadone maintenance for opioid dependence, and to evaluate the efficacy of contingency management (CM) for cocaine use disorders in reducing HIV risk behaviors. Methods African American (N=47), Hispanic (N=47), and White women (N = 29) were randomized to standard methadone treatment or standard methadone treatment plus a CM intervention. They completed the HIV Risk Behavior Scale (HRBS) indicating frequency of drug use and sexual behaviors across the lifetime, in the month before baseline, and in the 3 months following clinical trial participation. Ethnic group differences and the effect of CM on change in HIV risk behaviors between baseline and follow-up were evaluated. Results White women reported significantly higher lifetime rates of risky drug use and sexual behaviors on the HRBS than African American women; neither group differed significantly from Hispanic women. No ethnic group differences in HIV risk behaviors were identified in the month prior to baseline. At follow-up, African American women reported fewer high-risk drug use behaviors than White or Hispanic women, and Hispanic women reported more high-risk sexual behaviors than White or African American women. CM was associated with reduction in high-risk drug use behaviors regardless of ethnicity, but did not affect high-risk sexual behaviors. Conclusions White women receiving methadone maintenance engage in more lifetime HIV risk behaviors than African American women. CM for cocaine use reduces risky drug use behaviors, but certain ethnic groups may benefit from additional targeted HIV prevention efforts. PMID:18684571 Brown, J; McGowan, J A; Chouial, H; Capocci, S; Smith, C; Ivens, D; Johnson, M; Sathia, L; Shah, R; Lampe, F C; Rodger, A; Lipman, M We sought to evaluate whether people living with HIV (PLWH) using effective antiretroviral therapy (ART) have worse respiratory health status than similar HIV-negative individuals. We recruited 197 HIV-positive and 93 HIV-negative adults from HIV and sexual health clinics. They completed a questionnaire regarding risk factors for respiratory illness. Respiratory health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and the Medical Research Council (MRC) breathlessness scale. Subjects underwent spirometry without bronchodilation. PLWH had worse respiratory health status: the median SGRQ Total score was 12 [interquartile range (IQR) 6-25] in HIV-positive subjects vs. 6 (IQR 2-14) in HIV-negative subjects (P respiratory health appears more common in HIV-positive adults, and has a significant impact on health-related quality of life. © 2017 The Authors HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association. Rotger, Margalida; Glass, Tracy R; Junier, Thomas; Lundgren, Jens; Neaton, James D; Poloni, Estella S; van 't Wout, Angélique B; Lubomirov, Rubin; Colombo, Sara; Martinez, Raquel; Rauch, Andri; Günthard, Huldrych F; Neuhaus, Jacqueline; Wentworth, Deborah; van Manen, Danielle; Gras, Luuk A; Schuitemaker, Hanneke; Albini, Laura; Torti, Carlo; Jacobson, Lisa P; Li, Xiuhong; Kingsley, Lawrence A; Carli, Federica; Guaraldi, Giovanni; Ford, Emily S; Sereti, Irini; Hadigan, Colleen; Martinez, Esteban; Arnedo, Mireia; Egaña-Gorroño, Lander; Gatell, Jose M; Law, Matthew; Bendall, Courtney; Petoumenos, Kathy; Rockstroh, Jürgen; Wasmuth, Jan-Christian; Kabamba, Kabeya; Delforge, Marc; De Wit, Stephane; Berger, Florian; Mauss, Stefan; de Paz Sierra, Mariana; Losso, Marcelo; Belloso, Waldo H; Leyes, Maria; Campins, Antoni; Mondi, Annalisa; De Luca, Andrea; Bernardino, Ignacio; Barriuso-Iglesias, Mónica; Torrecilla-Rodriguez, Ana; Gonzalez-Garcia, Juan; Arribas, José R; Fanti, Iuri; Gel, Silvia; Puig, Jordi; Negredo, Eugenia; Gutierrez, Mar; Domingo, Pere; Fischer, Julia; Fätkenheuer, Gerd; Alonso-Villaverde, Carlos; Macken, Alan; Woo, James; McGinty, Tara; Mallon, Patrick; Mangili, Alexandra; Skinner, Sally; Wanke, Christine A; Reiss, Peter; Weber, Rainer; Bucher, Heiner C; Fellay, Jacques; Telenti, Amalio; Tarr, Philip E; Schölvinck, Elisabeth H. BACKGROUND: Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the Gwadz, Marya; Leonard, Noelle R; Honig, Sylvie; Freeman, Robert; Kutnick, Alexandra; Ritchie, Amanda S Annual HIV testing is recommended for populations at-risk for HIV in the United States, including heterosexuals geographically connected to urban high-risk areas (HRA) with elevated rates of HIV prevalence and poverty, who are primarily African American/Black or Hispanic. Yet this subpopulation of "individuals residing in HRA" (IR-HRA) evidence low rates of regular HIV testing. HIV stigma is a recognized primary barrier to testing, in part due to its interaction with other stigmatized social identities. Guided by social-cognitive and intersectionality theories, this qualitative descriptive study explored stigma as a barrier to HIV testing and identified ways IR-HRA manage stigma. In 2012-2014, we conducted in-depth qualitative interviews with 31 adult IR-HRA (74% male, 84% African American/Black) with unknown or negative HIV status, purposively sampled from a larger study for maximum variation on HIV testing experiences. Interviews were audio-recorded and professionally transcribed verbatim. Data were analyzed using a systematic content analysis approach that was both theory-driven and inductive. Stigma was a primary barrier to HIV testing among IR-HRA. In the context of an under-resourced community, HIV stigma was experienced as emerging from, and being perpetuated by, health care organizations and educational institutions, as well as community members. Participants noted it was "better not to know" one's HIV status, to avoid experiencing HIV-related stigma, which could interact with other stigmatized social identities and threaten vital social relationships, life chances, and resources. Yet most had tested for HIV previously. Factors facilitating testing included health education to boost knowledge of effective treatments for HIV; understanding HIV does not necessitate ending social relationships; and tapping into altruism. In the context of economic and social inequality, HIV stigma operates on multiple, intersecting layers. IR-HRA struggle with an aversion to Palazzolo, Sarah L; Yamanis, Thespina J; De Jesus, Maria; Maguire-Marshall, Molly; Barker, Suyanna L The purpose of this study was to explore the contextual factors that determine or mitigate vulnerability to HIV among Latina transgender women. Documentation status (legal authorization to live in the United States) has been cited by other studies as a barrier to recruitment or engagement in HIV-related care among immigrant Latinos, but not explored as a determinant of HIV risk for transgender immigrant Latinas. We collaborated with a community-based organization to explore these contextual, including social and structural, factors. In-depth interviews in Spanish captured life histories of eight 18- to 29-year-old transgender Latinas, who collectively self-identify as chicas trans. Codes were assigned deductively from the interview guide, and emerging themes were identified throughout data collection. Most participants migrated to the United States from Central America after experiencing discrimination and violence in their countries of origin. Participants emphasized documentation status as a critical factor in three areas related to social and structural determinants of HIV risk: gender identity expression, access to services, and relationship power dynamics. Chicas trans who gained legal asylum reported greater control over sexual relationships, improved access to services, and less risky employment. Documentation status emerged as a key HIV risk factor for this population. For undocumented transgender Latinas, legal asylum appears to be a promising HIV-related protective factor. Further research could assess whether legal assistance combined with wraparound support services affects HIV prevention for this population. Ann C Miller Full Text Available Russian Federation's (RF HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961 randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months, clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female at baseline. Forty-six participants (23.5% endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR3.93, 95% confidence interval (CI 1.95, 7.95, age under 41 (OR:2.97, CI:1.46, 6.04, drug addiction(OR: 3.60 CI:1.10, 11.77, history of a sexually transmitted disease(STD(OR 2.00 CI:1.02, 3.90, low social capital (OR:2.81 CI:0.99, 8.03 and heavier alcohol use (OR:2.56 CI: 1.02, 6.46 were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58, incarceration history(OR: 3.56 CI:1.55, 8.17 and STD history (OR: 3.48, CI: 1.5, 8.10 continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed. Objective: To identify abnormal levels of urine metabolites and cells that serve as markers of existing kidney disorders in ambulatory HIV-infected patients. Design: A cross sectional study. Setting: Nyanza Provincial General Hospital's patient support centre. Subjects: A total of 593 HIV infected patients were studied. Worm, Signe W; Hsue, Priscilla with risk of CVD. Biomarkers associated with inflammation such as C-reactive protein and interleukin-6 have been suggested to improve risk stratification among intermediate-risk persons; however, their routine use is not recommended in the general population. Both biomarkers have recently been reported......-infected population and will increase as this population continues to age. Identification of intermediate-risk individuals using biomarkers will be an important tool for clinicians in the future to be able to treat HIV-infected individuals aggressively. Future studies of biomarkers among individuals with HIV... Aunon, Frances M.; Wagner, Glenn J.; Maher, Rabih; Khouri, Danielle; Kaplan, Rachel L.; Mokhbat, Jacques Male sex workers (MSW) are a particularly high-risk subset of men who have sex with men in Lebanon and report higher numbers of sex partners and lower rates of condom use. The purpose was to explore the factors influencing sexual risk behaviors and HIV testing among MSW. Qualitative interviews were conducted with 16 MSW living in Beirut and working in bathhouses (hammam) or as escorts; content analysis identified emergent themes. Escorts reported more consistent condom use with clients and HIV testing than hammam MSW, with influential factors including HIV risk knowledge and perceived risk susceptibility, job security, and internalized stigma and related feelings of self-worth and fatalism regarding health and HIV risk. In contrast, both groups of MSW typically opted not to condoms with nonclient sex partners, in an effort to differentiate sex for work versus pleasure. The uptake of HIV testing was limited by concerns about the confidentiality of the test results and fear of repercussions of a positive test result for their health and employment. The respondents described an insular existence within the sex work culture, in part to limit exposure to stigma, which has implications for access to support as well as the influence of peer norms regarding sexual risk behavior and health seeking behaviors such as HIV testing. Further research is needed to tailor prevention and HIV testing efforts to reflect the distinct sexual health “cultures” that distinguish these two populations of MSW in Lebanon. PMID:25950906 Factors influencing the vulnerability of women to the risk of HIV-infection in rural villages in North West Province, South Africa. ... Gender and Behaviour ... This particular study found that there are a number of personal, proximal and distal factors that influence the vulnerability of women to HIV-infection in rural villages in ... Pronyk, Paul M; Kim, Julia C; Abramsky, Tanya; Phetla, Godfrey; Hargreaves, James R; Morison, Linda A; Watts, Charlotte; Busza, Joanna; Porter, John Dh To assess effects of a combined microfinance and training intervention on HIV risk behavior among young female participants in rural South Africa. : Secondary analysis of quantitative and qualitative data from a cluster randomized trial, the Intervention with Microfinance for AIDS and Gender Equity study. Eight villages were pair-matched and randomly allocated to receive the intervention. At baseline and after 2 years, HIV risk behavior was assessed among female participants aged 14-35 years. Their responses were compared with women of the same age and poverty group from control villages. Intervention effects were calculated using adjusted risk ratios employing village level summaries. Qualitative data collected during the study explored participants' responses to the intervention including HIV risk behavior. After 2 years of follow-up, when compared with controls, young participants had higher levels of HIV-related communication (adjusted risk ratio 1.46, 95% confidence interval 1.01-2.12), were more likely to have accessed voluntary counseling and testing (adjusted risk ratio 1.64, 95% confidence interval 1.06-2.56), and less likely to have had unprotected sex at last intercourse with a nonspousal partner (adjusted risk ratio 0.76, 95% confidence interval 0.60-0.96). Qualitative data suggest a greater acceptance of intrahousehold communication about HIV and sexuality. Although women noted challenges associated with acceptance of condoms by men, increased confidence and skills associated with participation in the intervention supported their introduction in sexual relationships. In addition to impacts on economic well being, women's empowerment and intimate partner violence, interventions addressing the economic and social vulnerability of women may contribute to reductions in HIV risk behavior. Full Text Available Co-infection with Hepatitis B (HBV virus and HIV is common due to similarity of their transmission methods. However, the prevalence of concurrent infection in different societies, shows the crucial role of various risk factors in different populations. Therefore, the present study was performed to examine risk factors of transmission of HBV in patients with HIV in a care center for AIDS patients in Rasht City. This case-control study was carried out on 60 HIV positive patients, who visited the Infectious Diseases Center of Razi Hospital of Rasht from November, 2015 to March, 2016. Participants were assigned to two 30-member experiment and control groups. They were adjusted in terms of age group (18-30, 30-40, 40-50, and 50-60, gender (male and female, and marital status (married, single, divorced, and widowed and visited by an infectious diseases specialist according to routine examinations. Data was recorded in a questionnaire for each subject. The mean age for the experimental group was 35±6.1, and for control group was 36.6± 5.7 years. Both univariate and multivariate analyses of development of HBV infection and variables including Illegitimate sexual intercourse, use of intravenous injection drugs, positive history of imprisonment, and tattooing (p value < 0.05 showed existence of significant relationships. Injection of illegal intravenous drugs, history of imprisonment, illegitimate sexual intercourse, and tattooing are four important risk factors for transmission of HBV infection to HIV patients. In addition, the master risk reduction program may include provision of clean disposable tools for intravenous injection of drugs and tattooing. Pauline E. Jolly Full Text Available Abstract Background Cervical Cancer (CC is the number one cancer among women in sub-Saharan Africa. Although CC is preventable, most women in developing countries do not have access to screening. Methods This cross-sectional study was conducted to determine the prevalence and risk factors for cervical lesions using visual inspection with acetic acid (VIA among 112 HIV positive and 161 negative women aged 18–69 years. Results The presence of cervical lesions was greater among HIV positive (22.9% than HIV negative women (5.7%; p < 0.0001. In logistic models, the risk of cervical lesions among HIV positive women was 5.24 times higher when adjusted by age (OR 5.24, CI 2.31–11.88, and 4.06 times higher in a full model (OR 4.06, CI 1.61–10.25, than among HIV negative women. In the age-adjusted model women who had ≥2 lifetime sexual partners were 3 times more likely (OR 3.00, CI 1.02–8.85 to have cervical lesions compared to women with one lifetime partner and the odds of cervical lesions among women with a history of STIs were 2.16 greater (OR 2.16, CI 1.04–4.50 than among women with no previous STI. In the fully adjusted model women who had a previous cervical exam were 2.5 times more likely (OR 2.53, CI 1.06–6.05 to have cervical lesions than women who had not. Conclusions The high prevalence of HIV infection and the strong association between HIV and cervical lesions highlight the need for substantial scale-up of cervical screening to decrease the rate of CC in Swaziland. Bloom, Shelah S; Agrawal, Alpna; Singh, Kaushalendra K; Suchindran, Chirayath M This study investigated the distribution and determinants of HIV risks among married couples in North India. Gender inequality emerged as a potential driver of HIV risks in this region. Data collection took place in 2003 in a probability survey of 3385 couples living in India's most populous state - Uttar Pradesh - and Uttaranchal. Couples' analyses utilizing generalized estimating equations showed that compared with husbands, wives were less knowledgeable about HIV (OR = 0.31, 95% CI = 0.27-0.36), more likely to consider themselves at risk for infection (OR = 6.86, 95% CI = 4.65-10.13), and less likely to feel that a wife had the right to refuse sex with her husband (OR = 0.50, 95% CI = 0.44-0.58). The proportion of husbands reporting non-marital sex in the past year was 7.1% and transactional sex in the past year, 2.2%. Among their wives, 73.4% were unaware of their husbands' non-marital sexual behaviors and only 28.9% of husbands reported condom use during their last non-marital sexual encounter. Logistic regression analyses showed that husbands' alcohol use, husbands' mobility, and urban residence were positively associated with husbands' non-marital sexual behaviors adjusting for other covariates. The data demonstrate that HIV prevention programs among couples in North India should consider both sexual risks and gender inequalities which potentially fuel HIV spread in this region. Setia, Maninder Singh; Lindan, Christina; Jerajani, H R; Kumta, Sameer; Ekstrand, Maria; Mathur, M; Gogate, A; Kavi, A R; Anand, V; Klausner, Jeffrey D Men who have sex with men and transgenders are an important risk group for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). They have risky sexual behaviors but low risk perception. To assess the sexual behavior, STIs, HIV and identify factors associated with HIV in men who have sex with men (MSM) and transgenders (TGs) in Mumbai. Participants were enrolled from two clinics in Mumbai. They completed an interviewer-administered questionnaire and were evaluated for STIs and HIV infection. A total of 150 participants, 122 MSM and 28 TGs were evaluated; 17% of MSM and 68% of the TGs were HIV infected. HIV infection in MSM was associated with serological positivity for HSV2 IgG [adjusted odds ratio (aOR), 95% confidence interval (CI): 9.0 (2.2-36.9)], a positive Treponema pallidum hemagglutination assay (TPHA) [aOR (95% CI): 6.0 (1.5-24.0)], greater than five acts of receptive anal sex in the past six months [aOR (95% CI): 4.3 (1.2-15.0)] and per category increase in age (18-24 yrs, 25-29 yrs, > 30 yrs) [aOR (95% CI): 3.1 (1.3-7.1)] in multivariate analysis. Consistent condom use during receptive anal sex in the past six months was low (27%). Many MSM were married (22%) or had sex with females and may act as a 'bridge population'. HIV infection in TGs was associated with a positive TPHA [OR (95% CI): 9.8 (1.5-63.9)] and HSV 2 IgG [OR (95% CI): 6.7 (1.1-40.4)] in univariate analysis. Prior STIs were strongly associated with HIV infection in MSM and TGs. These groups should be the focus of intensive intervention programs aimed at STI screening and treatment, reduction of risky sexual behavior and promotion of HIV counseling and testing. Full Text Available Abstract Background HIV-infected women, particularly those with advanced disease, may have higher rates of pregnancy loss (miscarriage and stillbirth and neonatal mortality than uninfected women. Here we examine risk factors for these adverse pregnancy outcomes in a cohort of HIV-infected women in Zambia considering the impact of infant HIV status. Methods A total of 1229 HIV-infected pregnant women were enrolled (2001–2004 in Lusaka, Zambia and followed to pregnancy outcome. Live-born infants were tested for HIV by PCR at birth, 1 week and 5 weeks. Obstetric and neonatal data were collected after delivery and the rates of neonatal ( Results The ratio of miscarriage and stillbirth per 100 live-births were 3.1 and 2.6, respectively. Higher maternal plasma viral load (adjusted odds ratio [AOR] for each log10 increase in HIV RNA copies/ml = 1.90; 95% confidence interval [CI] 1.10–3.27 and being symptomatic were associated with an increased risk of stillbirth (AOR = 3.19; 95% CI 1.46–6.97, and decreasing maternal CD4 count by 100 cells/mm3 with an increased risk of miscarriage (OR = 1.25; 95% CI 1.02–1.54. The neonatal mortality rate was 4.3 per 100 increasing to 6.3 by 70 days. Intrauterine HIV infection was not associated with neonatal morality but became associated with mortality through 70 days (adjusted hazard ratio = 2.76; 95% CI 1.25–6.08. Low birth weight and cessation of breastfeeding were significant risk factors for both neonatal and early mortality independent of infant HIV infection. Conclusions More advanced maternal HIV disease was associated with adverse pregnancy outcomes. Excess neonatal mortality in HIV-infected women was not primarily explained by infant HIV infection but was strongly associated with low birth weight and prematurity. Intrauterine HIV infection contributed to mortality as early as 70 days of infant age. Interventions to improve pregnancy outcomes for HIV-infected women are needed to Pinzón, María Virgínia; Tello, Ines Constanza; Rincón-Hoyos, Hernan Gilberto; Galindo, Jaime Abstract Objetive: To determine HIV presence and risk behaviors of persons of low socio-economic status in the city of Popayan-Colombia. Methods: Cross-sectional study; between 2008 and 2009, 363 participants of Popayan signed informed consent and received pre and post HIV test counseling. Socio-demographic characteristics and history of STDs, risk behaviors and previous HIV testing were assessed. Descriptive statistics, correlations and multivariate logistic regression were calculated. Results: Mean age 33.5±10,2; 66 %women. Frequency of HIV-positive patients was 3.86 % (95% CI:1.87-5.85), greater in men (7.38%; p= 0.013). Greater frequency of HIV-positive patients was observed in people age 29-37, those without a stable partner, and those with history of risky alcohol consumption (more than five drinks in 2 h). Conclusions: HIV-positive patients frequency in this population was greater than national estimate for general population, aged 15-49 in Colombia, with even greater frequency in men. This study suggests that characteristics associated with low socioeconomic status, in economically active population, without a stable partner and with risky alcohol use, can potentially increase risk of HIV infection. PMID:24892315 Champion, Jane Dimmitt; Szlachta, Alaina The HIV testing, disclosure, and sexual practices of ethnic minority men suggest that addressing sexual risk behavior and the underlying reasons for not receiving HIV testing or disclosing HIV-infection status-unique to differing populations-would improve public health interventions. Descriptive behaviors and underlying perspectives reported in our study suggest that public health interventions for HIV-infected Latino men who self-identify as heterosexual should explicitly identify substance use, needle sharing, and unprotected sex to current partners as behaviors placing both oneself and one's partners at high risk for contracting HIV. However, diversity of sexual behavior among gay, straight, and bisexual HIV-infected Latino men in our study ultimately suggested that clinicians should not rely on simplistic conceptions of sexuality in assessment of self-care needs. Care in presentation and discussion of self-identified sexual preference and sexual behavior is indicated, as these do not determine actual sexual orientation or behavior and vice versa. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved. Koh, Kwee Choy; Yong, Lit Sin We describe the HIV risk perception, sexual behavior, and HIV prevalence among 423 men-who-have-sex-with-men (MSM) clients who received voluntary counseling and testing (VCT) services at a community-based center in Kuala Lumpur, Malaysia. The mean age was 29 years old. One hundred one (23.9%) clients rated themselves as low risk, 118 (27.9%) as medium risk, 36 (8.5%) as high risk, and 168 (39.7%) were unsure of their risk. Twenty-four (9.4%) clients tested HIV positive (4 (4%) low risk, 9 (7.... Bhattarai, Manjula; Baniya, Jagat Bahadur; Aryal, Nirmal; Shrestha, Bimal; Rauniyar, Ramanuj; Adhikari, Anurag; Koirala, Pratik; Oli, Pardip Kumar; Pandit, Ram Deo; Stein, David A; Gupta, Birendra Prasad HBV and HCV infections are widespread among the HIV-infected individuals in Nepal. The goals of this study were to investigate the epidemiological profile and risk factors for acquiring HBV and/or HCV coinfection in disadvantaged HIV-positive population groups in Nepal. We conducted a retrospective study on blood samples from HIV-positive patients from the National Public Health Laboratory at Kathmandu to assay for HBsAg, HBeAg, and anti-HCV antibodies, HIV viral load, and CD4+ T cell count. Among 579 subjects, the prevalence of HIV-HBV, HIV-HCV, and HIV-HBV-HCV coinfections was 3.62%, 2.93%, and 0.34%, respectively. Multivariate regression analysis indicated that spouses of HIV-positive migrant labourers were at significant risk for coinfection with HBV infection, and an age of >40 years in HIV-infected individuals was identified as a significant risk factor for HCV coinfection. Overall our study indicates that disadvantaged population groups such as intravenous drug users, migrant workers and their spouses, female sex workers, and men who have sex with HIV-infected men are at a high and persistent risk of acquiring viral hepatitis. We conclude that Nepalese HIV patients should receive HBV and HCV diagnostic screening on a regular basis. Marchewka, Zofia; Szymczak, Aleksandra; Knysz, Brygida Significant survival prolongation in HIV-infected patients due to effective antiretroviral therapy is connected with increasing prevalence of chronic non-infective diseases in this population, among them chronic kidney disease. The pathogenesis of kidney disease in the setting of HIV includes conditions specific for HIV infection: direct effect of the virus, stage of immunodeficiency and drug toxicity. Chronic comorbidities, such as diabetes mellitus, hypertension, and hyperlipidemia, are additional significant risk factors of kidney disease. In HIV-infected individuals some distinct features of these conditions are observed, which are partly related to the virus and antiretroviral therapy. The article summarizes the effect of comorbidities on kidney function in HIV-infected persons. Chen, Derrick J; Yao, Joseph D Updated recommendations for HIV diagnostic laboratory testing published by the Centers for Disease Control and Prevention and the Association of Public Health Laboratories incorporate 4th generation HIV immunoassays, which are capable of identifying HIV infection prior to seroconversion. The purpose of this study was to compare turnaround time and cost between 3rd and 4th generation HIV immunoassay-based testing algorithms for initially reactive results. The clinical microbiology laboratory database at Mayo Clinic, Rochester, MN was queried for 3rd generation (from November 2012 to May 2014) and 4th generation (from May 2014 to November 2015) HIV immunoassay results. All results from downstream supplemental testing were recorded. Turnaround time (defined as the time of initial sample receipt in the laboratory to the time the final supplemental test in the algorithm was resulted) and cost (based on 2016 Medicare reimbursement rates) were assessed. A total of 76,454 and 78,998 initial tests were performed during the study period using the 3rd generation and 4th generation HIV immunoassays, respectively. There were 516 (0.7%) and 581 (0.7%) total initially reactive results, respectively. Of these, 304 (58.9%) and 457 (78.7%) were positive by supplemental testing. There were 10 (0.01%) cases of acute HIV infection identified with the 4th generation algorithm. The most frequent tests performed to confirm an HIV-positive case using the 3rd generation algorithm, which were reactive initial immunoassay and positive HIV-1 Western blot, took a median time of 1.1 days to complete at a cost of $45.00. In contrast, the most frequent tests performed to confirm an HIV-positive case using the 4th generation algorithm, which included a reactive initial immunoassay and positive HIV-1/-2 antibody differentiation immunoassay for HIV-1, took a median time of 0.4 days and cost $63.25. Overall median turnaround time was 2.2 and 1.5 days, and overall median cost was $63.90 and $72.50 for Meyer, D.; Behrens, G.; Stoll, M.; Schmidt, R.E. Osteonecrosis is a rare complication of HIV infection. The presumptive cause of the aseptic osteonecrosis is a disturbed blood supply to the bone. Most cases of osteonecrosis are associated with numerous risk factors, such as use of steroids, alcohol abuse, coagulopathies or metabolic derangements. Since conventional X-rays appear unremarkable, early forms often go unrecognized or are diagnosed late. Methods of establishing the diagnosis are MRI and three-phase skeletal scintigraphy. The pathogenesis of osteonecrosis in HIV infection is unclear. So far, about 30 cases have been reported in the literature. We would recommend that in HIV patients with typical symptoms - in particular when classical risk factors are present - osteonecrosis be included in the differential diagnostic considerations. (orig.) [de Meque, Ivete; Dubé, Karine; Feldblum, Paul J.; Clements, Archie C. A.; Zango, Arlinda; Cumbe, Fidelina; Chen, Pai Lien; Ferro, Josefo J.; van de Wijgert, Janneke H. To estimate the prevalence, incidence and determinants of herpes simplex type 2 (HSV-2) infection, and associations between HSV-2 and incident HIV infection, among women at higher risk for HIV infection in Beira, Mozambique. Between 2009 and 2012, 411 women aged 18-35 years at higher risk of HIV Rotger, Margalida; Glass, Tracy R; Junier, Thomas; Lundgren, Jens; Neaton, James D; Poloni, Estella S; van 't Wout, Angélique B; Lubomirov, Rubin; Colombo, Sara; Martinez, Raquel; Rauch, Andri; Günthard, Huldrych F; Neuhaus, Jacqueline; Wentworth, Deborah; van Manen, Danielle BACKGROUND: Persons infected with human immunodeficiency virus (HIV) have increased rates of coronary artery disease (CAD). The relative contribution of genetic background, HIV-related factors, antiretroviral medications, and traditional risk factors to CAD has not been fully evaluated in the setting of HIV infection. METHODS: In the general population, 23 common single-nucleotide polymorphisms (SNPs) were shown to be associated with CAD through genome-wide association analysis. Using the ... Guilamo-Ramos, Vincent; Padilla, Mark; Cedar, Anna Lindberg; Lee, Jane; Robles, Gabriel Expansion of the tourism industry in the Dominican Republic has had far-reaching health consequences for the local population. Research suggests families with one or more members living in tourism areas experience heightened vulnerability to HIV/STIs due to exposure to tourism environments, which can promote behaviors such as commercial and transactional sex and elevated alcohol use. Nevertheless, little is known about how tourism contexts influence family dynamics, which, in turn, shape HIV risk. This qualitative study examined family relationships through in-depth interviews with 32 adults residing in Sosúa, an internationally known destination for sex tourism. Interviewees situated HIV risk within a context of limited employment opportunities, high rates of migration, heavy alcohol use, and separation from family. This study has implications for effective design of health interventions that make use of the role of the family to prevent HIV transmission in tourism environments. Guilamo-Ramos, Vincent; Padilla, Mark; Cedar, Anna Lindberg; Lee, Jane; Robles, Gabriel Expansion of the tourism industry in the Dominican Republic has had far-reaching health consequences for the local population. Research suggests families with one or more members living in tourism areas experience heightened vulnerability to HIV/STIs due to exposure to tourism environments, which can promote behaviors such as commercial and transactional sex and elevated alcohol use. Nevertheless, little is known about how tourism contexts influence family dynamics, which, in turn, shape HIV risk. This qualitative study examined family relationships through in-depth interviews with 32 adults residing in Sosúa, an internationally known destination for sex tourism. Interviewees situated HIV risk within a context of limited employment opportunities, high rates of migration, heavy alcohol use, and separation from family. This study has implications for effective design of health interventions that make use of the role of the family to prevent HIV transmission in tourism environments. PMID:23436038 Full Text Available Abstract Background Heterosexual contact is the most common mode of HIV transmission in India that is largely linked to sex work. We assessed the non-use of condoms in sex work and with regular sex partners by female sex workers (FSWs, and identified its associations that could assist in planning HIV prevention programmes. Methods Detailed documentation of various aspects of sex work, and sexual behaviour with regular sex partners, was done through confidential interviews for 6648 FSWs in 13 districts in the Indian state of Andhra Pradesh. Multivariate analysis was done to understand condom non-use with clients. Results 5010 (75.4%, 1499 (22.5%, and 139 (2.1% FSWs were street-, home-, and brothel-based, respectively. Of the total 6648 FSWs, 6165 (92.7% had penetrative vaginal/anal sex with at least one client in the last 15 days, and of these 2907 (47.2%; 95% CI 41.2–53.2% reported non-use of condom with at least one of her last three clients. Lack of knowledge that HIV could be prevented (odds ratio 5.01; 95% CI 4.38–5.73, no access to free condoms (odds ratio 3.45; 95% CI 2.99–3.98, being street-based as compared with brothel-based (odds ratio 3.36; 95% CI 1.87–6.04, and no participation in FSW support groups (odds ratio 2.02; 95% CI 1.50–2.70 were the most significant predictors of condom non-use with clients. Other associations included lower social support, lower income, age >24 years, illiteracy, and living in medium-size urban or rural areas. Of the 2582 who had penetrative sex with regular sex partner within the last 7 days, 2428 (94%; 95% CI 92.1–95.9% had not used condom at last sex, and 1032 (41.8% had neither used condom consistently with clients nor with regular sex partner. Conclusion About half the FSWs do not use condom consistently with their clients in this Indian state putting them at high risk of HIV infection. Non-brothel-based FSWs, who form the majority of sex workers in India, were at a significantly higher Full Text Available Antiretroviral therapy (ART and condom use have been proven to reduce the risk of sexual transmission of human immunodeficiency virus (HIV among HIV sero-different couples, but its full implementation remains a challenge. This study aims to assess HIV seroconversion rate of HIV-negative spouse and its associated risk factors among HIV sero-different couples in rural China.An open cohort of HIV sero-different couples enrolled in 30 counties in China between October 1, 2010, and September 30, 2012, and followed-up to December 31, 2012, was constructed retrospectively. A nested case-control study of risk factors of HIV seroconversion among sero-different couples was conducted in April and May of 2013, based on the open cohort. Sero-different couples with the HIV-negative spouse seroconverting at least 3 months after the previous negative diagnosis during cohort observation period were labeled as "case couples". The "control couples" were selected randomly from the same cohort that did not have the HIV-negative spouse seroconversion during the same period. The "case couples" and "control couples" were matched on gender, age, and region of residence. Sexual behaviors among HIV sero-different couples before and after the index spouses notifying their HIV infection status to their HIV-negative spouses were collected via face-to-face interview. Univariate and multivariate logistic regression models were used to assess factors associated with HIV seroconversion among HIV sero-different couples.Of 4481 HIV sero-different couples, a total of 53 seroconversions were observed within 5218 person-years of follow-up. The incidence rate was 1.02 (95%CI: 0.76-1.33 per 100 person-years. Forty "case couples" confirmed HIV-negative spouse seroconversions infected via marital sexual transmission, were matched to 80 "control couples". Of the 120 couples, 81(67.5% were receiving ART, and 70 (58.3% reported consistently used condoms during intercourse after the index Tang, Houlin; Wu, Zunyou; Mao, Yurong; Cepeda, Javier; Morano, Jamie Antiretroviral therapy (ART) and condom use have been proven to reduce the risk of sexual transmission of human immunodeficiency virus (HIV) among HIV sero-different couples, but its full implementation remains a challenge. This study aims to assess HIV seroconversion rate of HIV-negative spouse and its associated risk factors among HIV sero-different couples in rural China. An open cohort of HIV sero-different couples enrolled in 30 counties in China between October 1, 2010, and September 30, 2012, and followed-up to December 31, 2012, was constructed retrospectively. A nested case-control study of risk factors of HIV seroconversion among sero-different couples was conducted in April and May of 2013, based on the open cohort. Sero-different couples with the HIV-negative spouse seroconverting at least 3 months after the previous negative diagnosis during cohort observation period were labeled as "case couples". The "control couples" were selected randomly from the same cohort that did not have the HIV-negative spouse seroconversion during the same period. The "case couples" and "control couples" were matched on gender, age, and region of residence. Sexual behaviors among HIV sero-different couples before and after the index spouses notifying their HIV infection status to their HIV-negative spouses were collected via face-to-face interview. Univariate and multivariate logistic regression models were used to assess factors associated with HIV seroconversion among HIV sero-different couples. Of 4481 HIV sero-different couples, a total of 53 seroconversions were observed within 5218 person-years of follow-up. The incidence rate was 1.02 (95%CI: 0.76-1.33) per 100 person-years. Forty "case couples" confirmed HIV-negative spouse seroconversions infected via marital sexual transmission, were matched to 80 "control couples". Of the 120 couples, 81(67.5%) were receiving ART, and 70 (58.3%) reported consistently used condoms during intercourse after the index spouse was Noumegni, Steve Raoul; Bigna, Jean Joel; Ama Moor Epse Nkegoum, Vicky Jocelyne; Nansseu, Jobert Richie; Assah, Felix K; Jingi, Ahmadou Musa; Guewo-Fokeng, Magellan; Leumi, Steve; Katte, Jean-Claude; Dehayem, Mesmin Y; Mfeukeu Kuate, Liliane; Kengne, Andre Pascal; Sobngwi, Eugene Cardiovascular disease (CVD) and metabolic diseases are growing concerns among patients with HIV infection as a consequence of the improving survival of this population. We aimed to assess the relationship between CVD risk and insulin resistance in a group of black African individuals with HIV infection. This cross-sectional study involved patients with HIV infection aged 30-74 years and followed up at the Yaoundé Central Hospital, Cameroon. Absolute CVD risk was calculated using the Framingham and the DAD CVD risk equations while the HOMA-IR index was used to assess insulin resistance (index ≥2.1). A total of 452 patients (361 women; 80%) were screened. The mean age was 44.4 years and most of the respondents were on antiretroviral therapy (88.5%). The median 5-year cardiovascular risk was 0.7% (25th-75th percentiles: 0.2-2.0) and 0.6% (0.3-1.3) according to the Framingham and DAD equations respectively. Of all participants, 47.3% were insulin resistant. The Framingham equation derived absolute CVD risk was significantly associated with insulin resistance; while no linear association was found using the DAD equation. The relationship between cardiovascular risk and insulin resistance in black African patients with HIV infection seems to depend on the cardiovascular risk equation used. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Gayatri, Y. A. A. A.; Sukmawati, D. D.; Utama, S. M.; Somia, I. K. A.; Merati, T. P. Tuberculosis is causes of mortality and morbidity in patients with HIV. Hypovitaminosis D, a defective cell-mediated immune response to Mycobacterium tuberculosis infection has been extensively described in HIV patients, but studies assessing the role of vitamin D in TB-HIV co-infection are lacking. We, therefore, conducted a 1:1 pair- matched case-control study to verify hypovitaminosis D possible risk factor of TB- HIV co- infection. Consecutive HIV patients starting ARV and sex, age and CD4 cell count matched were by recruiting. Tuberculosis has confirmed by thepresence of acid-fast bacilli in sputum or mycobacterium detected in specimens culture/Gene Xpert/PCR. Vitamin D levels were by measuring direct chemiluminescent immunoassay on a LIAISON®25OH analyzer. The study comprised 25 cases and 25 controls, median (interquartile range) 25(OH)D3 serum concentration were 19.80 (12.15-27.45) ng/mL in cases and 33.30 (27.2-39.4) ng/mL in controls (PHIV patients.(OR 26.154 (90% CI: 4.371-156.541); p HIV co-infection. Shayo, Elizabeth H; Kalinga, Akili A; Senkoro, Kesheni P; Msovela, Judith; Mgina, Erick J; Shija, Angela E; Materu, Godlisten; Kilima, Stella P; Mboera, Leonard E G; Massaga, Julius J Female anal sex is a receptive type of sexual practice among heterosexual couples where the penis is inserted into the anus of a female partner. In the Western world, a number of studies and interventions have been carried out on anal sex among men due to its potential risks to HIV transmission. In African countries, including Tanzania, there is dearth of information on the risks inherent in practices associated with female anal sex in the general population. The objective of this study was to determine the prevalence and risk factors associated with female anal sex in fuelling HIV transmission in selected districts of Tanzania. This study was conducted in four districts of Tanzania of Kinondoni, Tanga Urban, Makete and Siha. Both quantitative and qualitative methods i.e. household interviews and focus group discussions were employed in data collection. Study participants included community members of aged 15 and above such as heads of the household, adolescents, bar workers and commercial sex workers. A total of 903 individuals were interviewed, 60.6% of whom were females. When respondents were asked to indicate whether they had ever been tempted to practise FAS, 167 (18.5%) reported to have been tempted in the past 12 months. Of these, 44 (26.3%) respondents had at least practised FAS. Risky practices associated with FAS were forced sex, multiple partners, frequency of engaging in FAS, low use of condoms during FAS, low rates of HIV testing among partakers, poor perception of the risks to acquire HIV through FAS and use of lubricants. In this population, the frequency of FAS practice was rather low. And yet, FAS practice attendant risk factors are likely to exacerbate HIV transmission. As such, there is a need for further exploratory studies to determine and document drivers of FAS. In addition, public health education should be provided with regard to the risks of contracting HIV associated with FAS practices. Using criminal law powers to respond to people living with HIV (PHAs) who expose sexual partners to HIV or transmit the virus to them is a prominent global HIV public policy issue. While there are widespread concerns about the public health impact of HIV-related criminalization, the social science literature on the topic is limited. This article responds to that gap in knowledge by reporting on the results of qualitative research conducted with service providers and PHAs in Canada. The article draws on a studies in the social organization of knowledge perspective and insights from critical criminology and work on the "medico-legal borderland." It investigates the role played by the legal concept of "significant risk" in coordinating criminal law governance and its interface with public health and HIV prevention. In doing so, the article emphasizes that exploring the public health impact of criminalization must move past the criminal law--PHA dyad to address broader social and institutional processes relevant to HIV prevention. Drawing on individual and focus group interviews, this article explores how criminal law governance shapes the activities of providers engaged in HIV prevention counseling, conceptualized as a complex of activities linking clinicians, public health officials, front-line counselors, PHAs, and others. It emphasizes three key findings: (1) the concept of significant risk poses serious problems to risk communication in HIV counseling and contributes to contradictory advice about disclosure obligations; (2) criminalization discourages PHAs' openness about HIV non-disclosure in counseling relationships; and (3) the recontextualization of public health interpretations of significant risk in criminal proceedings can intensify criminalization. Copyright © 2011 Elsevier Ltd. All rights reserved. Majer, John M.; Komer, Anne C.; Jason, and Leonard A. Objective The relationship between mental illness and human-immunodeficiency virus (HIV)-risk sexual behavior among persons with substance use disorders is not well established because of differences in assessing psychiatric factors (types, symptoms, severity), substance use (diagnosis, survey responses, past substance use) and HIV-risk sexual behaviors (individual measures, combination of sex/drug use risk behaviors) across studies. This study utilized a more global and dimensional aspect of psychiatric issues (problem severity), to examine the relationship with HIV-risk sexual behaviors and substance use among persons with substance use disorders. Methods Participants included 224 men and 46 women, with a mean age of 40.4 years (SD = 9.5). The most common substances were heroin/opiates, with 41.4% reporting use of these substances (n = 110, 110/266), while 27.8% reported using cocaine (n = 74, 74/266) and 12.8% reported using alcohol (n = 34, 34/266). Of all participants, 39 (14.4%) were identified as having high psychiatric severity (defined using the psychiatric severity score from the Addiction Severity Index), which was used as an indication of probable comorbid psychiatric and substance use disorders. Among these participants likely to have comorbid disorders, hierarchical linear regression was conducted to examine HIV-risk sexual behaviors (number of partners and unprotected sexual behaviors in the past 30 days) in relation to psychiatric severity, substance use, and gender. Results Gender (women) and psychiatric severity (higher) were significantly related to greater HIV-risk sexual behaviors. After entering gender and substance use into the regression model, psychiatric severity accounted for another 21.9% of the variance in number of partners and 14.1% of the variance in unprotected sexual behaviors. Overall, the models accounted for 55.5% and 15.6% of the variance, respectively. A significant interaction was found for number of partners (but not Holstad, Marcia McDonnell; Spangler, Sydney; Higgins, Melinda; Dalmida, Safiya George; Sharma, Sanjay The purpose of this study was to identify key psychosocial characteristics of HIV-infected women who exhibit different levels of both ART adherence and risk behaviors. We analyzed baseline data from 193 predominately African American HIV-infected women participating in a behavioral clinical trial. Women were categorized into high/low groups based on levels of adherence and risky behaviors. There was a significant interaction effect for internal motivation for adherence. Women at high risk for poor health and transmitting HIV (low adherence/high risk group) had the lowest levels of internal motivation and also reported more difficult life circumstances. Gender roles, caretaking and reliance on men for economic and other support may promote external versus internal motivation as well as riskier behaviors in this group. The highest levels of internal motivation were found in those with High Adherence/High Risk behaviors. This group was highly knowledgeable about HIV and had the lowest VL. Compared to others, this group seems to tolerate risky behaviors given their high level of adherence. Adherence and risk reduction behaviors are key to individual and public health. Motivation and risk compensation should be addressed when providing interventions to women living with HIV. Full Text Available Abstract Background While the association of human papillomavirus (HPV with cervical cancer is well established, the influence of HIV on the risk of this disease in sub-Saharan Africa remains unclear. To assess the risk of invasive cervical carcinoma (ICC associated with HIV and HPV types, a hospital-based case-control study was performed between September 2004 and December 2006 in Kampala, Uganda. Incident cases of histologically-confirmed ICC (N=316 and control women (N=314, who were visitors or care-takers of ICC cases in the hospital, were recruited. Blood samples were obtained for HIV serology and CD4 count, as well as cervical samples for HPV testing. HPV DNA detection and genotyping was performed using the SPF10/DEIA/LiPA25 technique which detects all mucosal HPV types by DEIA and identifies 25 HPV genotypes by LiPA version 1. Samples that tested positive but could not be genotyped were designated HPVX. Odds ratios (OR and 95% confidence intervals (CI were calculated by logistic regression, adjusting for possible confounding factors. Results For both squamous cell carcinoma (SCC and adenocarcinoma of the cervix, statistically significantly increased ORs were found among women infected with HPV, in particular single HPV infections, infections with HPV16-related types and high-risk HPV types, in particular HPV16, 18 and 45. For other HPV types the ORs for both SCC and adenocarcinoma were not statistically significantly elevated. HIV infection and CD4 count were not associated with SCC or adenocarcinoma risk in our study population. Among women infected with high-risk HPV types, no association between HIV and SCC emerged. However, an inverse association with adenocarcinoma was observed, while decrease in CD4 count was not associated with ICC risk. Conclusions The ORs for SCC and adenocarcinoma were increased in women infected with HPV, in particular single HPV infections, infections with HPV16- and 18-related types, and high-risk HPV types Full Text Available OBJECTIVES: To assess HIV incidence and its associated risk factors among young men who have sex with men (YMSM in urban areas, China. DESIGN: The study used a prospective cohort study design and standard diagnostic tests. METHODS: A twelve-month prospective cohort study was conducted among YMSM (18-25 years old in 8 large cities in China. The participants were recruited via snowball sampling. A total of 1102 HIV-negative YMSM completed baseline assessment, 878 YMSM participants completed 6-month follow-up, and 902 completed 12-month follow-up. HIV was screened by an enzyme-linked immunosorbent assay and confirmed with Western Blot. Syphilis was screened via rapid plasma reagent and confirmed by treponema pallidum particle agglutination assay. RESULTS: 78 HIV seroconversions were identified within 1168.4 person-year observations yielding an incidence rate of 6.7 per 100 person-years. HIV seroconversion was associated with non-student status (RR = 2.61, 90% CI = 1.3-5.26, low HIV transmission knowledge (RR = 8.87, 90% CI = 2.16-36.43, and syphilis infection (RR = 5.04, 90% CI = 2.57-9.90. CONCLUSIONS: Incidence of HIV among YMSM is high in urban areas of China. Interventions measures are required to contain the HIV epidemic within this population. de Wolf, F.; Goudsmit, J.; Paul, D. A.; Lange, J. M.; Hooijkaas, C.; Schellekens, P.; Coutinho, R. A.; van der Noordaa, J. One hundred and ninety eight men seropositive for human immunodeficiency virus (HIV) antibody and 58 HIV antibody seroconverters were studied for an average of 19.3 (SEM 0.5) months to assess the relation between HIV antigenaemia and the risk of developing the acquired immune deficiency syndrome Wall, Kristin M.; Kilembe, William; Vwalika, Bellington; Khu, Naw Htee; Brill, Ilene; Chomba, Elwyn; Johnson, Brent A.; Haddad, Lisa; Tichacek, Amanda; Allen, Susan Objective To determine the impact of hormonal contraceptive methods on risk of HIV acquisition among HIV-negative women cohabiting with HIV-positive male partners. Study design From 1994–2012, HIV discordant couples recruited from a couples’ voluntary HIV counseling and testing center in Lusaka, Zambia were followed longitudinally. HIV-negative partners were tested quarterly. This analysis is restricted to couples in which the man was HIV-positive and the woman was HIV-negative at enrollment and the man was not on antiretroviral treatment. Multivariate Cox models evaluated associations between time-varying contraceptive methods and HIV acquisition among women. Sensitivity analyses explored exposure misclassification and time-varying confounder mediation. Results Among 1393 couples, 252 incident infections occurred in women over 2842 couple-years (8.9 infections per 100 couple-years; 95% CI, 7.8–10.0). Multivariate Cox models indicated that neither injectable [adjusted hazard ratio (aHR)=1.2; 95% CI, 0.8–1.7], oral contraceptive pill (OCP, aHR=1.3; 95% CI, 0.9–1.8), or implant (aHR=1.1; 95% CI, 0.5–2.2) use was significantly associated with HIV acquisition relative to non-hormonal contraception controlling for woman's age, literacy and time-varying measures of genital ulceration/inflammation. This remained true when only looking at the subset of infections acquired from the spouse (82% of infections) and additionally controlling for baseline HIV viral load of the male partner, pregnancy status, and time-varying measures of sperm on a vaginal swab wet prep and self-reported unprotected sex. OCP and injectable users reported more unprotected sex (pcontraception and HIV acquisition risk in women. Condom use and reinforced condom counseling should always be recommended for HIV discordant couples. HIV testing of sex partners together is critical to establish HIV risk, ascertain couple fertility intentions and counsel appropriately. Implications These findings Prata, Ndola; Morris, Leo; Mazive, Elizio; Vahidnia, Farnaz; Stehr, Mark The relationship between individuals' perception of their risk for acquiring HIV and their use of condoms is poorly understood. Understanding this relationship is crucial to the development of effective strategies to fight HIV and AIDS. Data from the Mozambique 2001 Adolescent and Young Adult Reproductive Health and Behavior Risk Survey are used to compare 15-24-year-olds' assessments of their HIV risk with assessments based on current and past sexual behavior. In bivariate and probit regression analyses, the relationship between correct risk assessment and the likelihood of condom use at last intercourse is examined. Twenty-seven percent of women and 80% of men who considered themselves to have no risk or a small risk of contracting HIV were actually at moderate or high risk. For both men and women, the prevalence of condom use at last sex was more than twice as high among those who assessed their risk correctly (30% and 16%, respectively) as among those who did not (14% and 6%). Multivariate analysis showed that correct assessment was positively associated with condom use; the association was driven by use among never-married individuals. Never-married males who assessed their risk correctly were 18% more likely than other males to report condom use; never-married females, 17% more likely than other females. Educational messages should aim at enabling individuals to correctly assess their own HIV risk and encouraging behavior change based on self-assessment of risk. Charles Bitamazire Businge Full Text Available Background: The prevalence of HIV among antenatal clients in South Africa has remained at a very high rate of about 29% despite substantial decline in several sub-Saharan countries. There is a paucity of data on risk factors for incident HIV infection among antenatal mothers and women within the reproductive age bracket in local settings in the Eastern Cape, South Africa. Objective: To establish the risk factors for incident HIV infection among antenatal clients aged 18–49 years attending public antenatal clinics in rural Eastern Cape, South Africa. Design: This was an unmatched case–control study carried out in public health antenatal clinics of King Sabata District Municipality between January and March 2014. The cases comprised 100 clients with recent HIV infection; the controls were 200 HIV-negative antenatal clients. Socio-demographic, sexual, and behavioral data were collected using interviewer-administered questionnaires adapted from the standard DHS5 women's questionnaire. Multivariate logistic regression models were used to identify the independent risk factors for HIV infection. A p<0.05 was considered statistically significant. Results: The independent risk factors for incident HIV infection were economic dependence on the partner, having older male partners especially among women aged ≤20 years, and sex under the influence of alcohol. Conclusions: Therefore, effective prevention of HIV among antenatal mothers in KSDM must target the improvement of the economic status of women, thereby reducing economic dependence on their sexual partners; address the prevalent phenomenon of cross-generation sex among women aged <20 years; and regulate the brewing, marketing, and consumption of alcohol. Full Text Available While the HIV epidemic varies greatly by region and population group throughout China, the HIV incidence among men who have sex with men (MSM continues to rise at an alarmingly fast pace. We seek to analyze the risk factors associated with HIV infection among MSM recruited from different channels in large urban centers across China, in an attempt to shed light on the design of future targeted intervention strategies.A total of 33,684 MSM from 14 cities and one province were recruited from July to December 2011. Demographic (e.g. age, marital status, education and behavioral (e.g. condom use, HIV testing history data were collected using information collection cards. Blood samples were also collected to test for HIV and Syphilis.Participants were recruited from five different channels, and all demonstrated distinct characteristics. The overall rate of positive HIV screening was 6.27% and the rate of syphilis infection was 6.50%. Participants recruited from bathhouses had the highest HIV (11.80% and syphilis infection rates (11.20%. Participants who were infected with syphilis had the highest HIV-positive screening rate (13.75%; 95% CI OR, 2.33-3.06. living in the southwest region of the country (11.64%; OR=2.76, 95%CI OR 2.19-3.47, Being >20 years of age (P<0.001, living in the southwest region of the country (OR=2.76, 95%CI 2.19-3.47, not having sex with female over the previous 3 months (OR=1.27, 95%CI 1.09-1.48, no condom use during the last anal intercourse (OR=1.54, 95%CI 1.39-1.70 and other factors were all associated with a higher probability of having an HIV-positive test result.Depending on the way they are recruited, more targeted interventions are required to prevent the spread of HIV/AIDS among MSM with different characteristics and behaviors. Results from this study could provide evidence for researchers to conduct further studies and policy-makers to establish more effective and strategic interventions for MSM in China. Rich, Ashleigh; Scott, Kai; Johnston, Caitlin; Blackwell, Everett; Lachowsky, Nathan; Cui, Zishan; Sereda, Paul; Moore, David; Hogg, Robert; Roth, Eric Gay, bisexual, queer and other men who have sex with men are disproportionately affected by HIV in Canada. While up to 63% of transgender men identify as gay, bisexual or queer and report a variety of HIV sexual risk behaviours, transgender men are often overlooked within epidemiological HIV surveillance and research. While a growing body of research has begun to examine sexual risk for transgender gay, bisexual and queer men, most studies have been conducted in the USA. This study explored sexual HIV risk for this population in the Canadian context, specifically in British Columbia, in an environment of publically funded universal access to healthcare, including HIV testing and treatment. We conducted interviews with 11 gay, bisexual and queer transgender men. Participants' narratives suggest that HIV risk for these transgender men is shaped by a diversity of sexual behaviours, including inconsistent condom use, seeking partners online for greater safety and accessing HIV/STI testing and other healthcare services despite facing transition-related barriers. Public health prevention and health education must recognise the presence of transgender men and ensure health services and broader population health promotion meet the unique sexual health needs of this sub-population of gay, bisexual and queer men. Stolte, I G; Gras, M; Van Benthem, B H; Coutinho, R A; van den Hoek, J A This cross-sectional study among heterosexual migrant groups in south-eastern Amsterdam, the city area where the largest migrant groups live, provides an insight into HIV testing behaviour in this particular group. Participants were recruited at street locations (May 1997-July 1998) and interviewed using structured questionnaires. They also donated saliva for HIV testing. In total, 705 males and 769 females were included in this study (Afro-Surinamese (45%), Dutch-Antilleans (15%) and West Africans (40%)). Prior HIV testing was reported by 38% of all migrants (556/1479), of which only a minority (28%) had actively requested HIV testing. Multivariate logistic regression showed that not actively requesting HIV testing was more likely among younger (migrants, especially women (ORwomen: 4.79, p risk should be facilitated by promoting HIV testing and by improving accurate self-assessment of risk for HIV infection, especially among the groups that do not actively request HIV testing. This would increase HIV awareness and provide the opportunity of better medical care earlier in HIV infection. Background: It is estimated that over ten percent of the 36.7 million people living with HIV (PLWHIV) globally, are those aged ≥50 years. The objective of this study was to determine the prevalence and risk factors for HIV among adult aged 50 years and above in Rombo district, northern Tanzania. Methods: This cross ... Xu, Jiahong; Yeganeh, Nava; Camarca, Margaret; Morgado, Mariza G.; Watts, D. Heather; Mofenson, Lynne M.; Veloso, Valdilea G.; Pilotto, Jose Henrique; Joao, Esau; Gray, Glenda; Theron, Gerhard; Santos, Breno; Fonseca, Rosana; Kreitchmann, Regis; Pinto, Jorge; Mussi-Pinhata, Marisa M.; Ceriotto, Mariana; Machado, Daisy Maria; Bryson, Yvonne J.; Grinsztejn, Beatriz; Moye, Jack; Klausner, Jeffrey D.; Bristow, Claire C.; Dickover, Ruth; Mirochnick, Mark; Nielsen-Saines, Karin Background Sexually transmitted infections (STIs) including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and cytomegalovirus (CMV) may lead to adverse pregnancy and infant outcomes. The role of combined maternal STIs in HIV mother-to-child transmission (MTCT) was evaluated in mother-infant pairs from NICHD HPTN 040. Methodology Urine samples from HIV-infected pregnant women during labor were tested by polymerase chain reaction (PCR) for CT, NG, and CMV. Infant HIV infection was determined by serial HIV DNA PCR testing. Maternal syphilis was tested by VDRL and confirmatory treponemal antibodies. Results A total of 899 mother-infant pairs were evaluated. Over 30% had at least one of the following infections (TP, CT, NG, and/or CMV) detected at the time of delivery. High rates of TP (8.7%), CT (17.8%), NG (4%), and CMV (6.3%) were observed. HIV MTCT was 9.1% (n = 82 infants). HIV MTCT was 12.5%, 10.3%, 11.1%, and 26.3% among infants born to women with CT, TP, NG or CMV respectively. Forty-two percent of HIV-infected infants were born to women with at least one of these 4 infections. Women with these infections were nearly twice as likely to have an HIV-infected infant (aOR 1.9, 95% CI 1.1–3.0), particularly those with 2 STIs (aOR 3.4, 95% CI 1.5–7.7). Individually, maternal CMV (aOR 4.4 1.5–13.0) and infant congenital CMV (OR 4.1, 95% CI 2.2–7.8) but not other STIs (TP, CT, or NG) were associated with an increased risk of HIV MTCT. Conclusion HIV-infected pregnant women identified during labor are at high risk for STIs. Co-infection with STIs including CMV nearly doubles HIV MTCT risk. CMV infection appears to confer the largest risk of HIV MTCT. Trial registration NCT00099359. PMID:29304083 De Jesus, Maria; Taylor, Juanita; Maine, Cathleen; Nalls, Patricia Background To date, there are very few comparative US studies and none in DC that distinguish between US-born and foreign-born Black women to examine and compare their perceptions of HIV risk. This qualitative study, therefore, analyzes African American and East African women’s perceptions of HIV risk in the Washington DC Metropolitan area, which has the highest AIDS rate in the US. Methods Forty in-depth, semi-structured interviews and 10 cognitive interviews were conducted among a sample of 25 African American women and 25 East African born women between October 2012 and March 2013 to examine perceptions regarding HIV risk. The in-depth semi-structured interviews were preceded by the cognitive interviews and accompanying survey. Study protocol was reviewed and approved by the American University Institutional Review Board. Results Adopting Boerma and Weir’s Proximate Determinants conceptual framework to interpret the data, the results of the study demonstrate that African American and East African immigrant women have divergent perceptions of HIV risk. While African American women ascribe HIV risk to individual-level behaviors and choices such as unprotected sex, East African women attribute HIV risk to conditions of poverty and survival. Conclusions Study findings suggest that addressing HIV prevention and education among Black women in DC will require distinct and targeted strategies that are culturally and community-centered in order to resonate with these different audiences. PMID:26766523 Basten, Maartje; Heijne, Janneke Cornelia Maria; Geskus, Ronald; Daas, Chantal Den; Kretzschmar, Mirjam; Matser, Amy Sexual risk behaviour changes during a person's life course. Insights in sexual risk behaviour trajectories of MSM may provide starting points for the timing of HIV prevention methods. We aimed to study longitudinal trajectories of sexual risk behaviour predictive of HIV acquisition from sexual Full Text Available Abstract Background While men who have sex with men remain the group at greatest risk of acquiring HIV infection in the UK, the number of new diagnoses among heterosexuals has risen steadily over the last five years. In the UK, three-quarters of heterosexual men and women diagnosed with HIV in 2004 probably acquired their infection in Africa. This changing epidemiological pattern is particularly pronounced in East London because of its ethnically diverse population. Design and methods The objective of the study was to examine the social, economic and behavioural characteristics of patients with HIV infection currently receiving treatment and care in hospitals in East London. The research focused on ethnicity, gender, sexuality, education, employment, housing, HIV treatment, stigma, discrimination, religion, migration and sexual risk behaviour. People diagnosed with HIV infection attending outpatient treatment clinics at St Bartholomew's, the Royal London, Whipp's Cross, Homerton, Newham and Barking hospitals (all in East London over a 4–6 month period were invited to participate in the study in 2004–2005. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire. During the study period, 2680 patients with HIV attended the outpatient clinics in the six participating hospitals, of whom 2299 were eligible for the study and 1687 completed a questionnaire. The response rate was 73% of eligible patients and 63% of all patients attending the clinics during the survey period. Discussion A clinic-based study has allowed us to survey nearly 1700 patients with HIV from diverse backgrounds receiving treatment and care in East London. The data collected in this study will provide valuable information for the planning and delivery of appropriate clinical care, social support and health promotion for people living with HIV not only in East London but in other parts of the capital as well as elsewhere in the UK. Omland, Lars Haukali; Legarth, Rebecca; Ahlström, Magnus Glindvad . To estimate the risk of HIV diagnosis in the general population without any indicator diseases, we calculated the FYRHD starting at age 25, 35, 45, and 55 years. RESULTS: The risk in the male general population was substantially higher than the female general population, and the risk was lower in the older...... with relevant indicator diseases are nonexistent. METHODS: In a nationwide population-based cohort study encompassing all Danish residents aged 20-60 years during 1994-2013, we estimated the 5-year risk of an HIV diagnosis (FYRHD) after a first-time diagnosis of 147 prespecified potential indicator diseases... Diane Santa Maria Full Text Available While HIV disproportionately impacts homeless individuals, little is known about the prevalence of HIV risk behaviors in the southwest and how age factors and HIV risk perceptions influence sexual risk behaviors. We conducted a secondary data analysis (n = 460 on sexually active homeless adults from a cross-sectional study of participants (n = 610 recruited from homeless service locations, such as shelters and drop-in centers, in an understudied region of the southwest. Covariate-adjusted logistic regressions were used to assess the impact of age at homelessness onset, current age, age at first sex, and HIV risk perceptions on having condomless sex, new sexual partner(s, and multiple sexual partners (≥4 sexual partners in the past 12 months. Individuals who first experienced homelessness by age 24 were significantly more likely to report condomless sex and multiple sexual partners in the past year than those who had a later onset of their first episode of homelessness. Individuals who were currently 24 years or younger were more likely to have had condomless sex, new sexual partners, and multiple sexual partners in the past 12 months than those who were 25 years or older. Those who had low perceived HIV risk had lower odds of all three sexual risk behaviors. Social service and healthcare providers should consider a younger age at homelessness onset when targeting HIV prevention services to youth experiencing homelessness. Amirkhanian, Yuri A.; Kuznetsova, Anna V.; Kelly, Jeffrey A.; DiFranceisco, Wayne J; Musatov, Vladimir B.; Avsukevich, Natalya A.; Chaika, Nikolay A.; McAuliffe, Timothy L. Background Although the dire life circumstances of labor migrants working in Russia are well-known, their HIV risk vulnerability and prevention needs are understudied. Low socioeconomic status, lack of access to services, separation from family, and limited risk awareness all contribute to migrants’ HIV vulnerability. Methods Male labor migrants in St. Petersburg (n=499) were administered assessments of their sexual behavior practices, substance use, and psychosocial characteristics related to risk and well-being. Results Thirty percent of migrants reported multiple female partners in the past 3 months. Condom use was low, ranging from 35% with permanent to 52% with casual partners. Central Asian migrants had very low AIDS knowledge, low levels of substance use, moderate sexual risk, high depression, and poor social supports. Eastern European migrants had higher AIDS knowledge, alcohol and drug use, and sexual risk. Discussion Improved HIV prevention efforts are needed to reduce the risk vulnerability of migrants who relocate to high disease prevalence areas. PMID:20690041 An assessment of high risk sexual behaviour and HIV transmission among migrant oil workers in the Niger Delta area of Nigeria. ... questionnaires to evaluate key high – risk sexual behavioral parameters such as multiplicity of sexual partners, bisexuality (closet homosexuality), high grade sexual behaviour and lesbianism. Coping Strategies of young mothers at risk of HIV/AIDS in the Kassena-Nankana District of Northern Ghana. ... African Journal of Reproductive Health ... This qualitative study draws on interpretative principles with emphasis on understanding young mothers' vulnerability to HIV/AIDS and explores coping strategies used to ... Fujiwara, Esther; Tomlinson, Sara E; Purdon, Scot E; Gill, M John; Power, Christopher Human immunodeficiency virus (HIV) can affect the frontal-striatal brain regions, which are known to subserve decision-making functions. Previous studies have reported impaired decision making among HIV+ individuals using the Iowa Gambling Task, a task that assesses decision making under ambiguity. Previous study populations often had significant comorbidities such as past or present substance use disorders and/or hepatitis C virus coinfection, complicating conclusions about the unique contributions of HIV-infection to decision making. Decision making under explicit risk has very rarely been examined in HIV+ individuals and was tested here using the Game of Dice Task (GDT). We examined decision making under explicit risk in the GDT in 20 HIV+ individuals without substance use disorder or HCV coinfection, including a demographically matched healthy control group (n = 20). Groups were characterized on a standard neuropsychological test battery. For the HIV+ group, several disease-related parameters (viral load, current and nadir CD4 T-cell count) were included. Analyses focused on the GDT and spanned between-group (t-tests; analysis of covariance, ANCOVA) as well as within-group comparisons (Pearson/Spearman correlations). HIV+ individuals were impaired in the GDT, compared to healthy controls (p = .02). Their decision-making impairments were characterized by less advantageous choices and more random choice strategies, especially towards the end of the task. Deficits in the GDT in the HIV+ group were related to executive dysfunctions, slowed processing/motor speed, and current immune system status (CD4+ T-cell levels, ps Decision making under explicit risk in the GDT can occur in HIV-infected individuals without comorbidities. The correlational patterns may point to underlying fronto-subcortical dysfunctions in HIV+ individuals. The GDT provides a useful measure to assess risky decision making in this population and should be tested in larger studies. Kalichman, Seth C; Simbayi, Leickness C; Kaufman, Michelle; Cain, Demetria; Cherry, Chauncey; Jooste, Sean; Mathiti, Vuyisile This study examined gender attitudes and sexual violence-supportive beliefs (rape myths) in a sample of South African men and women at risk for HIV transmission. Over 40% of women and 16% of men had been sexually assaulted, and more than one in five men openly admitted to having perpetrated sexual assault. Traditional attitudes toward women's social and gender roles, as well as rape myths, were endorsed by a significant minority of both men and women. Multivariate analyses showed that for men, sexual assault history and rape myth acceptance, along with alcohol and other drug use history, were significantly related to cumulative risks for HIV infection. In contrast, although we found that women were at substantial risk for sexually transmitted infection (STI), including HIV, women's risks were only related to lower levels of education and alcohol use history. We speculate that women's risks for STI/HIV are the product of partner characteristics and male-dominated relationships, suggesting the critical importance of intervening with men to reduce women's risks for sexual assault and STI/HIV. Anglewicz, Philip; Clark, Shelley A large and increasing proportion of HIV transmissions in sub-Saharan Africa occur within marriage. Condom use within marriage could, therefore, be an important prevention strategy, but there is considerable debate about whether married couples would be willing to use condoms. This paper contributes to this debate by identifying key factors that affect the acceptability of condom use within marriage and actual condom use among men and women in rural Malawi, using three waves of longitudinal data from 2004, 2006 and 2008. Specifically, we focused on the effect of (1) entry into first marriage, (2) respondent's HIV status, HIV perceptions, and risk behaviors, and (3) spouse's HIV characteristics on condom use acceptability within marriage and actual condom use with a spouse or steady partner. Using fixed-effects regression, we found that getting married coincides with a pronounced attitudinal shift regarding the acceptability of condom use within marriage that cannot be explained by differences in fertility status or selection into marriage. In addition, we found that, for women, perceived HIV status of the respondent and spouse generally had greater influence than actual HIV status on the acceptability of condom use within marriage and actual condom use with a spouse or steady partner, even after HIV status is known; while actual HIV status and HIV risk behaviors are generally more important among men. Although condom use within marriage remained low, these findings suggest that attitudes about and use of condoms are susceptible to change and that both marital status and perceptions of risk are important influences on condom use. Copyright © 2013 Elsevier Ltd. All rights reserved. Full Text Available Significant survival prolongation in HIV-infected patients due to effective antiretroviral therapy is connected with increasing prevalence of chronic non-infective diseases in this population, among them chronic kidney disease. The pathogenesis of kidney disease in the setting of HIV includes conditions specific for HIV infection: direct effect of the virus, stage of immunodeficiency and drug toxicity. Chronic comorbidities, such as diabetes mellitus, hypertension, and hyperlipidemia, are additional significant risk factors of kidney disease. In HIV-infected individuals some distinct features of these conditions are observed, which are partly related to the virus and antiretroviral therapy. The article summarizes the effect of comorbidities on kidney function in HIV-infected persons. Full Text Available The availability of oral fluid HIV rapid testing provides an approach that may have the potential to expand HIV testing in China, especially among most-a-risk populations. There are few investigations about the acceptability of oral fluid HIV testing among most-at-risk populations in China.A cross-sectional study with men who have sex with men (MSM, female sex workers (FSW and voluntary counseling and testing (VCT clients was conducted in three cities of Shandong province, China from 2011 to 2012. Data were collected by face-to-face questionnaire.About 71% of participants were willing to accept the oral fluid HIV rapid testing, and home HIV testing was independently associated with acceptability of the new testing method among MSM, FSW and VCT clients (AOR of 4.46, 3.19 and 5.74, respectively. Independent predictors of oral fluid HIV rapid testing acceptability among MSM were having ever taken an oral fluid HIV rapid test (AOR= 15.25, having ever taken an HIV test (AOR= 2.07, and education level (AOR= 1.74. Engagement in HIV-related risk behaviors (AOR= 1.68 was an independent predictor of acceptability for FSW. Having taken an HIV test (AOR= 2.85 was an independent predictor of acceptability for VCT clients. The primary concern about the oral fluid HIV testing was accuracy. The median price they would pay for the testing ranged from 4.8 to 8.1 U.S. dollars.High acceptability of oral fluid HIV rapid testing was shown among most-at-risk populations. Findings provide support for oral rapid HIV testing as another HIV prevention tool, and provide a backdrop for the implementation of HIV home testing in the near future. Appropriate pricing and increased public education through awareness campaigns that address concerns about the accuracy and safety of the oral fluid HIV rapid testing may help increase acceptability and use among most-at-risk populations in China. Wyatt, Gail E; Gómez, Cynthia A; Hamilton, Alison B; Valencia-Garcia, Dellanira; Gant, Larry M; Graham, Charles E This article articulates a contextualized understanding of gender and ethnicity as interacting social determinants of HIV risk and acquisition, with special focus on African Americans and Hispanics/Latinos--2 ethnic groups currently at most risk for HIV/AIDS acquisition in the United States. First, sex and gender are defined. Second, a conceptual model of gender, ethnicity, and HIV risk and resilience is presented. Third, a historical backdrop of gender and ethnic disparities is provided, with attention to key moments in history when notions of the intersections between gender, ethnicity, and HIV have taken important shifts. Finally, new frontiers in psychology are presented, with recommendations as to how psychology as a discipline can better incorporate considerations of gender and ethnicity as not only HIV risk factors but also as potential avenues of resilience in ethnic families and communities. Throughout the article, we promulgate the notion of a syndemic intersectional approach, which provides a critical framework for understanding and building the conditions that create and sustain overall community health by locating gendered lived experiences and expectations within the layered conceptual model ranging from the biological self to broader societal structures that define and constrain personal decisions, behaviors, actions, resources, and consequences. For ethnic individuals and populations, health disparities, stress and depression, substance abuse, and violence and trauma are of considerable concern, especially with regard to HIV risk, infection, and treatment. The conceptual model poses new frontiers for psychology in HIV policy, research, interventions, and training. Ahmed, Syed Imran; Hassali, Mohamed Azmi; Aziz, Noorizan Abdul To evaluate the level of knowledge, attitudes, and risk perceptions of University Sains Malaysia final-year pharmacy students regarding human immunodeficiency virus (HIV) and acquired immunity deficiency syndrome (AIDS). A cross-sectional study among pharmacy students. Data were analyzed with Chi-square to find difference at p value AIDS patients. Students recommended HIV testing for health care professionals (69.4%) and patients (75.9%) before surgical procedures. Students knew little about Post Exposure Prophylaxis (18.5%) or about the time for HIV to develop into AIDS (57.4%). About 40% of students were unaware of the inability of antivirals to treat HIV/AIDS. Students had low awareness for opportunistic infections (18.5%), and low agreement on competency to treat and counsel HIV patients (12.9%). The study highlighted students' misconceptions, negative attitudes, and risk perceptions towards HIV/AIDS. Youth's perceptions of HIV infection risk: a sex-specific test of two risk models. ... The analysis is based on data from the 2003 Demographic and Health survey ... multiple partners, Nigeria, risk perception, sexual behaviour, vulnerability to HIV ... Tennille, Julie; Solomon, Phyllis; Fishbein, Martin; Blank, Michael An important step in research using the Theory of Reasoned Action and Theory of Planned Behavior (TRA/TPB) is conducting an elicitation process to identify topic and population specific cognitions. This study explored HIV risk behaviors in persons with mental illnesses and introduces findings from focus groups conducted during the development phase of an HIV primary and secondary prevention intervention study. Researchers held four focus groups with persons with mental illnesses focused on HIV

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Published on June 15th, 2015 | by Daniel Sherman Fernandez0 Fiat To Rebadge The Mitsubishi Triton Fiat Chrysler Automobiles and Mitsubishi Motors are working out the final details of a supply contract in which the Japanese automaker will provide the Fiat brand with a version of its new Thai-built L200 midsize pickup. Fiat plans to sell the pickup in Europe and Latin America, where demand for such models is growing. Mitsubishi started manufacturing its re-designed L200, also known as the Triton, in Laem Chabang last year. The Japanese carmaker aims to increase global sales of the new-generation L200 to 200,000 units a year from the 130,000 of the old model. Europe accounted for 10 percent of the previous L200’s sales, making it the pickup’s second-largest region after ASEAN, which includes Thailand, Malaysia and Vietnam. Mitsubishi won’t sell the L200 in the U.S., Canada and Japan. Fiat Chrysler is expected to start selling the pickup in 2016 under its Fiat Professional light commercial vehicle brand. Broadening Fiat Professional’s lineup is a crucial element of Fiat Chrysler CEO Sergio Marchionne’s plan to make the automaker’s European business consistently profitable. Fiat’s current lineup includes the Strada, a front-wheel-drive-only unibody small pickup built in Brazil and sold in Europe and Latin America. The Strada was Fiat’s top-selling pickup in Europe last year and ranked ninth overall despite having a volume of just 1,399 units, according to JATO Dynamics. The top-selling pickup in Europe last year was the Toyota Hilux (24,040 units) with the Ford Ranger (22,019), Volkswagen Amarok (16,007), Nissan Navara (13,451) and L200 (13,271) rounding out the top five. The overall segment is on the rise as pickup sales grew 5 percent last year to 114,892 compared with 2013.

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Published on April 25th, 2022 | by Amirul Mukminin0 Zurich Malaysia Shares 10 Balik Kampung Safety Tips As the old adage says, its better to be safe than sorry It’s hard to believe that it has been two long years since Malaysians were able to travel to their hometowns to celebrate and spend Hari Raya Aidilfitri with their loved ones. As the excitement builds for the upcoming balik kampung journey, Zurich Malaysia wants to remind all motorists to take simple steps to protect themselves and others on the road. To help motorists prepare their vehicle for the journey, the insurance company has compiled some useful tips to follow before and while on the road as a caring reminder this festive season. The aim is to make the journey home safer and more comfortable. - Make sure your tyres are in roadworthy condition and adequately inflated. Lack of tread equals less traction. If you have a tyre repair kit, make sure it hasn’t passed its used by date. - Check your brakes and brake fluid before you balik kampung. If you hear grinding, growling or squealing when braking, or notice a difference in braking performance, have them checked at the nearest petrol station or workshop. - Ensure your headlights, rear lights and brake lights are working, and the headlights are properly aligned for maximum visibility when driving at night. - Adhere to posted speed limits to avoid potential accidents or even getting a ticket. - Do not tailgate the vehicle in front of you. Following too closely reduces reaction time and increases risks of accidents which can cause damage and even injury. - Use your indicators for at least three seconds before making a move. Do not use hazard lights in the rain unless your car is stalled. Hazard lights indicate a stopped vehicle. Hence, it can be misleading and dangerous when your car is moving. - Texting or getting a non-handsfree call delays reaction time by up to 50%. No call or message is worth endangering your life or those around you. - Getting home on time is not an emergency. Do not hog the emergency lane to skip traffic. It should be clear for people who genuinely need to stop, or for emergency purpose. - Check your policy’s coverage before every renewal to keep it updated. You might want to include additional driver’s name or coverage, such as for special perils. It would be even better to have a life insurance or takaful plan. - Have emergency items such as road flare/emergency triangle, jumper cables, fire extinguisher and tyre repair kit handy in your vehicle. Road safety is more than just driving safely. It is how each life on the road is precious. More importantly, it is about how we can protect ourselves and our loved ones. Zurich Malaysia hopes all Malaysians will have a safe Hari Raya Aidilfitri this year and are prepared to create a brighter future.

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Cacaneal tuberosity, haglund heel The calcaneal tuberosity is an enlargement of the upper posterior calcaneal corner. Through shoe pressure, mechanical irritation can be caused to the surrounding soft parts such as bursae, Achilles tendon and sheaths. Often this "ganglion" is only irrating and painful in tight shoes. Sometimes this irritation can also result in spontaneous tears of the Achilles tendon. Through conservative therapy (measures to reduce swelling, shoe modifications, physiotherapy and special insoles) improvement can sometimes be achieved. The problem is only really solved by surgically removing the tuberosity and removal of the most inflamed bursa and sheaths. Surgical treatment of the high calcaneus Before: Preoperatively, an inflamed swelling can be seen at the typical site. This causes considerable pain, especially in tight shoes. Picture 3: The yellow file shows the high heel bone. In addition, the patient had a hump on the back of the foot (red arrow). After: The high fesen bone has been straightened through the keyhole (percutaneously) and is now no longer disturbing (yellow arrow). The hump of the back of the foot was also removed in the same way (red arrow). The operation is minimally invasive, i.e. through several small punctures. Although other foot problems were operated on in the same session, the patient is immediately able to walk normally. In the post-operative X-ray, it can be seen that very little bone was removed. Only the part of the bone that had pressed inside the shoe was removed very sparingly and selectively. Postoperatively almost no pain. This and the immediate mobilization with full load are the big differences to the open method. Full weight bearing from the fourth postoperative day, hospitalization few days. Operation on only one side office work can be resumed after approximately ten days, operation on both sides and heavy physical labour, after roughly 2 months. After approximately four weeks for less strenuous sports, after operation on both sides after approximately twoto four months for squash and tennis. Good results are achieved in almost 95 percent of cases. Infection in about 2 percent of cases, where however, the end result itself rarely affected by it. Left & Middle: The arrow indicates the calcaneal tuberosity. Right: The chiselled off surface must be smooth (red arrows). Particularly important is the "complaint corner" on the Achilles tendon insertion (yellow arrow), if the bone remains here, then a relapse is inevitable (recurrence of the same symptoms).

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Sustanon 250 jak stosowac, sustanon opinie Sustanon 250 jak stosowac The side-effects of sustanon 250 testosterone blend all medications, steroidal and non-steroidal alike carry with them possible negative side-effects, sustanon 250 makes no exception. The main problem with anabolic agents is the side effects they cause. This is even more true to the testosterone in supplementation; however, for sustanon 250 the side-effects are minimal, at no point is sustanon 250 found in your urine, Sustanon solo efekty. It's true that a man does suffer from sexual side-effects in spite of the use of anabolic steroids for many, many years, sustanon 250 ne zaman etki eder. Many men will try to overcome this, using other methods to avoid sexual problems, Sustanon 250 efekty. These methods are not effective when a man uses anabolic steroids. The use of anabolic steroids allows this to happen. Men suffer during the time of the use of anabolic steroids, sustanon 250 xanh. 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You can get good results from these diets for 4-6 weeks. Fasting and weight control (weight loss training) How long to fast: You should fast for 3-4 days depending on your goals, so if you want to do a complete fast you should fast for at least 6 days How much food you should eat: How long to fast: You should fast for 4-6 days, but you should eat at least 400 calories How much sleep you need: How long to fast: You should fast 4-6 days and eat at least 1600-2000 calories If you want to increase your results while losing fat fast, then you should focus on high protein, healthy fat, and low carbs, and you need to build muscle. You should check out the fasting vs. diet for bodybuilding vs. sedentary weight loss section of this article. What about training? How long to fast: You should eat for 4-6 days depending on your goals, so try a fast fasting vs. diet for training and fitness. 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How much food you should eat: How long to fast: You should eat at least Related Article:

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Imagine waking up and checking over your motorbike while buffalo roam the rice paddies surrounding you. The rolling hills are seaweed green; it’s already warm at 7 in the morning. Welcome to backpacking in Vietnam. Vietnam leapt into the 21st century so quickly, that much of its countryside is still buffering to catch up. So while you may spend weeks exploring Vietnamese jungle and villages where buffalo is the superior mode of transport, you will also encounter epic cities with high speed internet and commuter traffic. Backpacking Vietnam is always a highlight of someone’s Southeast Asia travels. It’s cheap, it has the best street food in the world, and it’s fascinating. It’s also easy to get around. There are trains, busses, motorbikes – and buffalo – that are easily available to the broke backpacker. The hardest decision when visiting Vietnam, is where to start! Like so many other veteran travellers, Vietnam still stands out as one of my favourite places in the world. So while this guide will share with you the best places to visit in Vietnam – and a few budget tricks – its main message is to touch down in the country yourself. Inevitably, you too will fall in love with the chaos and the banh mi. Avast! Let’s get planning to backpack Vietnam! Why Go Backpacking in Vietnam Travelling Vietnam has many of the classic markers of backpacking Southeast Asia. It still presents all the gorgeous sights: rolling green highlands, steaming jungles, twinkling azure coastlines, and ancient delights. There’s still an element of debauchery waking up still drunk in a city you don’t know. However, there’s an unshakable element of maturity that Vietnam asks of you. I think it’s partly that the horrific history of this country is still in your face. Some of the mountains are still pockmarked from the insane bombing they endured in the war of the 1960s and 1970s. It’s also partly because Vietnam was not a well-visited destination until the 1990s. Even today isn’t full of cookie-cutter tours to the same degree as its neighbouring countries. It’s also incredibly cheap to travel here. Vietnamese cuisine is sublime, the cities offer a metropolis-meets-charming-chaos style of living and the mountains? The mountains are damn fine. This has made it quite a popular base for English teachers, digital nomads, and other veteran traveller ex-pats. I found Vietnam to be a heady collision of worlds. One day you might be chilling in a Vietnamese village that hasn’t seen foreigners in forty years, and the next you’re kicking it with Vietnamese students who deal weed to the ex-pats next door. This all leads to this feeling that this is Southeast Asia. Or this is what Southeast Asia could be if there was a little more responsible tourism. Vietnam is a world away for most backpackers – and it sticks with them as a highlight of their years vagabonding Southeast Asia. Heading Off-Grid? • Download This Guide as a PDF! Sign up to The Broke Backpacker’s EXCLUSIVE VIP AREA below and download our top backpacking guides as PDFs – go offline with peace of mind! - Best Travel Itineraries for Backpacking Vietnam - Best Places to Visit in Vietnam - Top Things to Do in Vietnam - Backpacker Accommodation in Vietnam - Vietnam Backpacking Costs - Best Time to Travel to Vietnam - Staying Safe in Vietnam - How to Get Into Vietnam - How to Get Around Vietnam - Working in Vietnam - Culture in Vietnam - FAQs About Backpacking Vietnam - Final Advice Before Visiting Vietnam Below we have put together the grand tour itinerary. This is great if you have over 3 weeks to backpack Vietnam, and best completed by motorbike or bus! If you only have 2 weeks, aim to complete the first or second half of the itinerary. Vietnam is generally split into two regions, the north and the south. Deciding on where to stay in Vietnam, and what the best area for you is, can be a pretty hard decision. If you only have less than two weeks, you can focus on one region. Another popular way to backpack Vietnam is to combine a trip with a neighbouring country. For example, combining Southern Vietnam and Cambodia. 2-Week Travel Itinerary for Vietnam: The Quick Trip This trip is best done over about two weeks. It lends itself to bus travel in between some of Vietnam’s most iconic locations. You can start at either end, but I will talk about it from north to south. Flying into Hanoi will be an experience in itself. Hanoi is an epic blend of modern skyscrapers and streets full of mouthwatering foods. Be sure to check out the Temple of Literature while you’re there. After spending a few days in Hanoi, pop down the coast to the old imperial capital of Hue. My love affair with Vietnamese food was truly consummated here. Yes, if I could bed with the bun bo hue, I would. From Hue, it’s not too far to another beautiful Vietnamese city – Hoi An. Hoi An has a slow pace of living and it’s a good place to catch up on the first leg of your trip. You can stroll through the picturesque streets, and catch up on some market shopping. The chill times continue in Da Lat. It’s well worth taking a motorbike trip through the mountains on the way here -it’s stunning! Finish up your trip in Ho Chi Minh City! This trip has the best of Vietnam in one neat little 2-week package! 1-Month Travel Itinerary for Vietnam: The Grand Tour This itinerary can be complete in either direction, but I will discuss it from North to South. Start your trip backpacking in Hanoi – Vietnam’s beautiful capital city. Make a side trip to the countryside of Sapa, where you can ride your motorcycle through the hills and explore waterfalls. Then arrange a trip to Halong Bay, a highlight on any Vietnam trip. Head south, stopping to stay in the town of Hue, before moving on to visit Hoi An, where you can get an affordable, good quality suit made. Then go to Nha Trang to let loose, get a bit wild and have some fun on the water. A popular water sports area with the likes of windsurfing, paragliding and jet skiing on offer; there’s enough adrenaline here to keep even the most adventurous happy. Head to Mui Ne and for a short stay in Da Lat, then on to Saigon (Ho Chi Minh), the starting point for most backpackers travelling Vietnam. Saigon is a crazy bustling city. You can also go explore the Mekong River, a paradise for wildlife. There is one item every traveller NEEDS. Some travellers don’t even know they need it, but those travellers need it more than anyone. What is this forgotten essential of the backpacker-life? SPOILERS! Guess you’ll just have to click the button to find out. 😉Find Out What It Is! As I mentioned earlier, backpacking Vietnam is a collision of worlds. Some cities feel like old-world Asia, others still retain strong French colonial influences, and others are straight-up party hubs. Vietnamese cities are still among my favourite in the world – the heady mix of skyscrapers and good internet with carts selling pig ears and Chinese medicine peddled throughout them. There is so much to unpack and discover that I can give you my favourite places to go in Vietnam, but inevitably you’ll discover your own hidden gems. Always, there is colour and the smell of pho. One of my favourite cities in all of Asia, Hanoi is a beautiful combination of Old meets Modern: a gateway to the incredible mountains and scenery to the North and the warm beaches and bustling cities to the south. Hanoi is worth spending at least a couple of days exploring, on foot, or by bicycle. You could end up joining the ranks of ex-pats that call Hanoi home. In Hanoi, it is definitely worth visiting the War Museum, easily spotted it has a great collection of weaponry marking the entrance. It costs just $3 to get in and it’s a good introduction to exploring Vietnam’s war-torn past. Oh and be sure to check out the Old Quarter. It’s here that the traffic looks most like schools of fish, and that the best bowls of noodles can be found. As for my personal favourite places to visit in Hanoi? Other than the street carts selling banh mi until the early hours of the morning, it’s got to be the Temple of Literature. The Temple of Literature was founded in 1070. It was Vietnam’s first university where the rich and incredibly brainy attended. Even if you’re not into the history behind it, its handcrafted architecture is pretty breathtaking. If you aren’t templed out, definitely head over to the ‘old section’ of the city and stop by Bach Ma Temple aka the oldest temple in the city. If you only see one temple while backpacking through Hanoi, make it this one. Hoan Kiem Lake, also known as the ‘Lake of the Restored Sword’. The legend goes that once the Emperor defeated the Chinese from Hanoi, a giant golden turtle grabbed the sword and disappeared into the lake to restore it to its rightful owners. All traffic here is banned between 7 P.M. to midnight every Friday to Sunday turning this beautiful place into a meeting place for friends, giving it an almost funfair vibe. If you’re an early bird and like morning exercise, 6 am Thai Chi takes place every morning. Hanoi is a popular place to buy and sell motorbikes from or to other backpackers. It functions as both an entry and exit point to this epic country. As such, there is a contagious and frenetic energy in the hostels. You bump shoulders with those that have got stuck and fallen in love with Vietnam and those who are moving on. What a place to trade travel tips over a pint! An explorers paradise, you are likely to arrive here early in the morning. Check into one of the awesome hostels in Sapa, leave your bags here, and go in search of Motorbikes for hire! It’s around $10 per day to hire a motorbike. The price of freedom is cheap here. Getting lost on a Motorbike, exploring the beautiful countryside is just one of the many adventurous things to do in Sapa. Drive to the beautiful Thac Bac Waterfall, around 15kms outside Sapa main town. A legend says if you look at the falls long enough, you will see a white dragon peering down into the valley below. Get off the beaten track while backpacking Vietnam and take a day trip out of Sapa town and visit the incredible Ban Pho Village. One of the friendliest tribes in South East Asia, it stands out among others due to the Mongolian Ban Ha population here. Settled on a Mountainous cliffside these guys literally live life on the edge. Come and explore the culture, talk to the villagers and try not to get too drunk off the legendary corn wine they will insist you taste. Multiple times. If motorbikes aren’t your thing, you can still make an awesome tour of Sapa Valley by bicycle. If you go with a company all of your food and extra transportation (not on a bicycle) is covered, but it is easy enough to organize yourself. There are some truly awesome treks around Sapa and you could spend a few days (or a few lifetimes) here exploring. For the more adventurous, why not conquer Vietnams highest peak, Fansipan. Not quite Everest but standing at 3,143m it’s pretty impressive; it is possible to do in a day but most will recommend at least 2 days. You can do this hike solo or with trekking companies in the area. Backpacking Ha Giang If you fancy heading off on some even more adventure-fuelled forays, consider treks around the area or better yet, motorbiking the Ha Giang Loop! It’s one of the most under-appreciated areas in Vietnam and attracts far fewer Western tourists than Sapa. Although it’s getting more and more popular every day, there are still some hidden gems here, like the remote lake of Na Hang. There’s plenty of ripe adventure material left to find travelling in this part of Vietnam. When looking for accommodation in Ha Giang, be sure to check out our friends at Hmong Moonshine! They are great people (ask for Tuyen) and the property itself is very beautiful. You can also learn how to make local moonshine while staying here! Allegedly, this is where I was drunk under the table by a Vietnamese grandma… Turns out I can’t hold my moonshine as well as the locals – who knew! Backpacking Halong Bay & Cat Ba Island This UNESCO world heritage site, often known as the Eighth Wonder of the world, is an unmissable stop whilst backpacking Vietnam. Almost everyone who visits Halong Bay does it as part of a pre-arranged package. I’m not normally one for taking the tour option but it is pretty impossible otherwise. The tour’s not too expensive and it was totally worth it. We had a great time and were surrounded by some awesome people. It’s essential to prebook your trip and accommodation in Halong Bay; we booked a two day, two-night tour from our stay at the Central Hanoi Backpackers Hostel. Whilst exploring Halong Bay we stayed on a cool ‘Junk Boat‘ one night and in beach huts the other. Being part of a prepackaged tour meant all our food, transport and everything else was included, making it a hassle-free adventure. Once the tour is over you can either stay on Cat Ba island and check out the rock climbing scene or head back to Hanoi for a night before travelling South. This is a beautiful small town offering a great break in the journey from Hanoi to Hoi An. One of Vietnams most royal cities, Hue is littered with impressive historic sights, delighting the inner nerd in us all! There are also heaps of cool backpacker hostels in Hue with bouncing little traveller vibes. It is one of Vietnam’s sticky spots – it’s just so easy to get stuck exploring and chilling out here. There is a slower pace of life compared with some of the other cities in Vietnam. Check out the impressive Citadel on the other side of the perfume river. This impressive piece of history is made up of 4 separate citadels and will take a full day to explore. So you can hire a bike to get around! There is a ton of things to do in Hue and you could easily spend weeks here. Check out the Thien Mu Pagoda; standing at 21 metres high and decorated with mind-blowing architecture this pagoda is a pretty spectacular eyeful. If rest and relaxation are what you are after the beaches of Lang Co and the mineral hot pools of Phong An are just a short distance away. Worldpackers connects travellers with hostels, schools, NGO’s and many more. Get free accommodation in exchange for volunteering a few hours a day. You won’t just save serious $$$, you’ll experience a different culture, cool projects, meet new people and integrate into the community in a different way. Broke Backpacker readers get a $10 discount when you sign up. Use the discount code BROKEBACKPACKER. Plus, get 3 free months on your membership during their summer promo!Travel well with Worldpackers Backpacking Hoi An Hoi An is THE place to get tailor-made clothes whilst backpacking Vietnam. There are loads of things to do but most backpackers visiting Hoi An come here to get a suit made. Clothes tend to take at least 3 days to make so you want to get measured as soon as possible… So first stop? Find a tailor! Check into Hoi An Vietnam Backpackers Hostel – dorms start from $7 USD a night, and it has an awesome pool! Spend a few days exploring the local area by bicycle. (The hostel provides them for free.) It’s located close to the beach which is great on hot days, as you don’t have to go far! Looking to get back into the city? Da Nang is a great day trip, only a 40-minute drive from Hue; the sandy beaches, caves and Buddhist shrines among many other activities make for the perfect day out. Backpacking Nha Trang Nha Trang is a perfect place to let loose, get a bit wild, and have some fun on the water. A popular water sports area with the likes of windsurfing, paragliding, and jet skiing on offer, there’s enough adrenaline here to keep even the most adventurous happy. No need to prebook; all can be arranged from the beach. The best area to stay in Nha Trang is down the side alleys and not on the main road. It’s quieter, cheaper, and just more chill. Something I found interesting about Nha Trang was its popularity with wealthy Russian tourists. I wasn’t expecting to eat mystery meat soup next to a large Slavic man with a shiny watch but hey, that’s travelling! Some of the bars popular with backpackers here can err on the side of dodgy, so keep your wits about you. There are some great backpacker hostels in Nha Trang with awesome social vibes. The beaches are beautiful and there’s a pretty laid back vibe to backpacker life here. There is a strange feeling that hovers over Nha Trang that I can’t quite put my finger on. It made me love it all the more, but still, there’s an oddity to it. I think it’s got to do with the availability of cheap drugs and the associated changes to locals – and tourists who get hooked – that this brings. Rumours of Russian mafia activity abound and some of the hookers are pretty good pickpockets too. This all contrasts with a stunning, postcard-perfect exterior to create the ‘odd’ feeling. Nha Trang is one of those interesting places that you’ll be glad you went to, but also, probably glad you left. Backpacking Lak Lake Recover from the heavy nights in Nha Trang and break up the journey to Dalat by venturing out to the tranquil and beautiful Lak Lake, the largest natural body of water in central Vietnam. This region of Vietnam is home to the Mnong people. An ethnic group indigenous to Vietnam (with a small population in Cambodia too), the Mnong people, rather curiously, are renowned for designing one of the world’s oldest instruments: the lithophone. Paddle out in a kayak at sunset and enjoy the still waters and beautiful scenery. You can also explore Jun Village: A Mnong settlement of wooden stilted houses. It’s a very beautiful place to go in Vietnam and a slight departure from the regular tourist trail. Backpacking Mui Ne From Nha Trang you can head to Mui Ne which is home to one of the best beaches in Vietnam. You can check out the awesome sand dunes or hire a motorbike from Easy Rider for roughly 30 dollars and ride up the mountain paths to Dalat. There isn’t much other than the sand dunes, beaches, and a fairy stream in Mui Ne. Ostrich riding is totally a thing though, which sounds totally awesome but it’s really kind of fucked. I am going to please ask you to consider your actions when engaging with animal tourism. That is to say, please don’t ride the ostriches. Bombing the sand dunes is plenty fun enough. Backpacking Da Lat (Dalat) There is not a whole lot to do in Da Lat, but the ride itself is very scenic. I managed to crash and hurt myself quite badly because the roads are difficult, and if you have limited riding experience I suggest you hire a driver and just go on the back of the bike. Although it’s not as stacked with activities as a lot of other destinations in Vietnam, there are still awesome budget accommodations in Dalat for backpackers to stay at. It’s a nice place in Vietnam to stay and take a breather for a few days. I liked slowing down and getting to know the quieter side of Vietnam while in Da Lat. I couchsurfed here and we barbequed octopus and played hopscotch with the kids until late in the night. It’s one of those little memories that didn’t feel special at the time but has stuck out as a wonderful memory as the years have gone on. Backpacking Ho Chi Minh (Saigon) The starting point for most visitors to Vietnam, backpacking in Ho Chi Minh City (formerly known as Saigon) is a crazy bustling experience. Expensive for us broke backpackers in comparison to the rest of the country, I recommend venturing into the ‘real’ Vietnam pronto. Although there are plenty of cool things to do in Ho Chi Minh, many of the ‘must-see’ sights around are related to the terrors of the Vietnam War. The War Remnants Museum is a haunting insight into the life of those fighting on the front line during the period of 1954 – 1975. It costs around $1 to enter. Take a trip out of the city and tour the incredible network of Cu Chi Tunnels. Brave claustrophobia and crawl around the safer sections of the restored tunnels, popping (or squeezing) out at the other end. You can pre-book half-day tours of the tunnels through the Hide Out Hostel travel desk. From Ho Chi Minh, it is easy to arrange a bus onwards to Phnom Penh in Cambodia. You get your Cambodian visa for a fee on the border. Mekong Delta is often referred to as the ‘Rice Bowl’ of Vietnam (there are lovely rice paddies everywhere) this maze of rivers, swamps and islands are home to tiny villages floating on the banks of the Delta. Paddle into the floating markets and pick up some cheap trinkets, you’ll find anything and everything. Unfortunately, the market is becoming increasingly popular and much of the trinkets being sold are aimed at those travelling Vietnam. If you have a day to kill in the Mekong consider renting a vintage Vespa scooter and checking out the Delta countryside and local culture. Moving past the ‘tourist’ trap section, the Mekong Delta is a paradise for local wildlife. The quiet and noise of nature is a refreshing change from the busy streets of Ho Chi Minh. Trips to the Mekong can be as quick as half a day or a couple of days, depending on budget. However, I would recommend spending at least a day exploring the Mekong Delta. The best place to stay when exploring the Mekong Delta is Can Tho, just south of Ho Chi Minh Getting Off the Beaten Path in Vietnam Vietnam is certainly shooting up as a popular destination for both backpackers and holidayers. While you can stick to exploring the typical areas of Vietnam that most people visit, there is so much more to discover once you get off the tourist trail. The Ha-Giang Loop (which I’ve already mentioned) is one such choice. It’s not one of Vietnam’s completely hidden gems anymore, however, it’s still far from touristic. Even attempting the Ha-Giang Loop by motorbike is going to give a feeling of real adventure material while simultaneously bringing you into closer contact with local communities. As an extension of that, travelling Vietnam by motorbike (while definitely a common activity for tourists) brings even more potential for exploring the unseen sides of the country. The good thing about having your own wheels is that you can go anywhere! No village is too far off the beaten track. I’m also going to throw the suggestion of the Ta Xua mountain range at you. Close to Moc Chau village (another underexplored locale), the Ta Xua mountains give the feeling of walking above the heavens themself. Mountain trails wind the ranges over oceans of rolling cloud formations – sunrise is a real treat. And lastly, if you’re packing for a beach day but prefer the feeling of lost isolation, Vietnam has heaps of lesser-known beaches to explore too! Just heading north up the coast from Nha Trang is going to land you in some dope spots like Quy Nhon. If you’re still keen to branch out from there, just rent a bike and start looking! Top Things to Do in Vietnam Vietnam is loaded with cool activities – both for lovers of tourist affairs and for lovers of the road less travelled. Here’s my top pick of the coolest things to do in Vietnam! 1. Cruise Halong Bay No journey to Vietnam is complete without a trip to check out Ha Long Bay. Admire the breathtaking scenery of mountainous limestone rocks while cruising Halong Bay. When the humidity hits take a leap off the side and into the tranquil water below and splash around till your heart’s content. 2. Squeeze into the Cu Chi Tunnels See how the Vietnamese used underground tactics during the Vietnam War. Squeeze yourself into the tiny tunnels, overcoming claustrophobia as you try to experience what the Vietnamese Soldiers once did back in 1954. 3. Trekking in Sapa Leave the hustle and bustle behind and check into some of the most beautiful mountainous landscapes in Asia. Home to Vietnam’s highest peak Fansipan, Sapa is a dream to trek, and standing at 3,143m it’s pretty impressive. If this is a bit too adventurous, enjoy the day walks or simply kick back and take in the beautiful views. 4. Suit up in Hoi An Thailand has Elephant Pants and Vietnam has incredible Silk Suits. Watch the talented tailors at work in Hoi An and get your own creation made cheaply, beautifully, and in just a few hours! 5. Water Puppet Show Originating as far back as the 11th Century from the villages of the Red River Delta in Northern Vietnam, Water Puppet Shows are incredible. Lasting from as little as 5 minutes to hours, these are shows that you have to check out when travelling in Vietnam. 6. Bar Hop Ba Hoi Friendly bars with cheap beer, laid back feels and even more friendly locals. Often located up sketchy looking side streets, these little bars are a great place for a laugh and cheap beer. 7. Street Food For as little as $1 for a great meal, you really have no excuse not to try some of the local delicacies. We’re talking the classic Banh Mi and fetal duck eggs. There’s turtle soup, pho, and beef in every way you can imagine. This country is simply spoiled with the finest food in Southeast Asia. 8. Motor Bike across the Country This is a fantastic way to see the countryside. Of course, more information is coming about exploring on 2 wheels in the motorbike travel section below. My missus travels with all her clothes in ziplock bags: don’t be like my missus. UP YOUR PACKING GAME! Packing cubes for the globetrotters and compression sacks for the real adventurers – these babies are a traveller’s best kept secret. They organise yo’ packing and minimise its volume too so you can pack MORE. Or, y’know… you can stick to ziplock bags.View Our Fave Cubes Or Check Out the Sacks! Vietnam has some of the cheapest accommodation in Southeast Asia. You can find a dorm bed for as little as $3 USD a night or a private room with a fan for $7 USD. The hostel scene is pretty awesome. It’s super diverse with party hostel, co-working spaces, and grungy, old school hostels all in the mix. You can expect to meet some interesting characters while staying in a hostel. This is where you can trade travel stories and pick up tips about where to go next. If hostels don’t sound like your thing – or maybe you just want to indulge in a double bed for a special occasion – Vietnam also has a range of great Airbnbs. You can stay in whole apartments for less than $50 a night. When that one guy at the hostel has told you the story about how he almost became an international drug smuggler but then he remembered about his ethics so he just dodged taxes instead, an Airbnb can seem more appealing for a night. And even luxury Airbnbs in Vietnam is not out of the question for a backpacker looking to splurge for one night. In between swanky Airbnbs and party hostels are a bunch of great guesthouses and homestays. Many of these aren’t listed online but are well known via word of mouth. Wherever you choose to stay in Vietnam, it’s not going to be expensive – but it will be a great time! The Best Places to Stay in Vietnam |Destination||Why Visit!||Best Hostel||Best Airbnb| |Hanoi||Hanoi is the bubbling metropolis that has everyone falling in love with Vietnam! Come for the pho, stay for the loveable chaos.||Hanoi Central Backpackers Hostel||Peaceful Rental Unit in Hanoi| |Sapa||Sapa still feels like the old Vietnam - the one of rolling rice paddies, moonshine, and friendly locals. It's more than a little dreamy here!||Ta Van Hostel||The Little Village, Sapa| |Ha Giang||If you're on your motorbike then get out to Ha Giang! It's offbeat, beautiful, and an unforgettable experience.||Hmong Moonshine||Hmong Moonshine Local Homestay| |Cat Ba Island||Cat Ba Island is not to be missed! Take in the other wordly scenery and enjoy a day on the water rather than in the jungle.||Cannon Fort Cat Ba Hostel||-| |Hue||The old imperial capital beckons you to come explore the ruins of ancient palaces and enjoy days wandering the cobblestone streets.||Hue Happy Homestay||Private Terrace in Hue| |Da Nang||Da Nang's highlight is surely its Golden Bridge, although there is so much more to discover! A jungle city with a great food scene is always a good time.||Travellers Nest Hostel||-| |Hoi An||Hoi An is Vietnam's city of lights. Enjoy the slower pace of life along the river and soak up the romantic atmosphere.||Vietnam Backpackers Hostel||One Bedroom River Suite| |Nha Trang||Nha Trang is an interesting must-see. From the Russian (mafia?) tourists to the delicious seafood, there's always something to discover along Nha Trang's coast.||Bondi Backpackers||Ocean View Apartment| |Mui Ne||Mui Ne is a charming beach town with epic sand dunes. Unleash your inner child and bomb your way down the dunes as quickly as possible!||Mui Ne Backpackers Hill||Spacious Fairy Hills| |Da Lat||Be careful on the motorbike ride into Da Lat, but be sure to enjoy the beauty and serenity once you do get here - this kind of quiet is hard to come by in Vietnam!||Mr Peace Backpackers||Valley View Home| |Ho Chi Minh||Ah, Saigon! The hustle to Hanoi's bustle. The beers are cheap, the music scene is thriving, and the markets are full of the best food in all of Asia. Hell yeah!||The Hideout||Colonial Flat| Travelling in Vietnam can be cheap without you really having to think about it. I spent around 20 dollars a day in Vietnam, sometimes a little more when splurging on a day trip or imported beer. You could very easily travel on less than 10 dollars a day, while still enjoying yourself. As I’ve (hopefully) made clear in this guide, I LOVE Vietnamese food! Mostly that’s because it’s so damn delicious, but partly it’s because it’s so cheap. If you spend $3 on a meal in Vietnam, you’re going to be full to the brim and overdosing on tastiness. A local beer costs around 80 cents, although imported beers are still expensive. Going out for a night to see some music or have drinks in a bar can be done for less than $10! (And that’s drinking A LOT!) Local transport is very cheap; though an airconditioned bus ride will be around $15. Generally speaking, the further from the city centres that you get, the cheaper life becomes. A Daily Budget in Vietnam |Expense||Broke Backpacker||Frugal Traveler||Creature of Comfort| |Total per day:||$9-$34||$37-$67||$80+| Money in Vietnam Ever wanted to throw cash in the air and feel like a millionaire? Well, the Vietnamese Dong allows every broke backpacker travelling in Vietnam the opportunity to feel rich. As of 09/11/21, $1 US = 22,660 Vietnamese Dongs – crazy huh? Plus the name is Dong… Which, when enjoying multiple dirt-cheap beers, is consistently amusing. Don’t try to obtain Vietnamese currency before entering the country, it’s pretty much impossible. If you managed to snag some, you’ve probably had a pretty bad exchange rate. Take US dollars into Vietnam, you’ll find many shops and services accept US dollars. Credit and Debit cards are widely accepted in the more built-up areas such as Ho Chi Minh and Hanoi but many of these, charge pretty insane withdrawal fees so it’s advisable to avoid small ATM transactions and get out a bunch of cash at once – just make sure you hide it well. For all matters of finance and accounting on the road, The Broke Backpacker strongly recommends Wise – The Artist Formerly Known as Transferwise! Our favourite online platform for holding funds, transferring money, and even paying for goods, Wise is a 100% FREE platform with considerably lower fees than Paypal or traditional banks. But the real question is… is it better than Western Union? Yes, it most certainly is. Travel Tips – Vietnam on a Budget Vietnam is one of the cheapest destinations in Asia. However, it is still possible to go a little out of control, especially when the currency makes you feel like a millionaire. Standard budget backpacking tips aside, here are my top tips to keep it for backpacking Vietnam on a budget… - Camp: Vietnam has some incredible countryside and coastline, views that shouldn’t be wasted by sleeping inside. Camping is most popular within the National Parks up and down Vietnam. Pack up your best backpacking gear and take adventures outdoor. - Take the Bus: The national bus service or ‘the chicken bus’ has great links throughout Vietnam, even into some of the more remote areas. For as little as $1 a ticket, I’d happily sit next to a chicken for a few hours. - Eat Street Food: Seriously, the food here is so cheap – and so declicious – you might as well indulge! Cooking for yourself probably won’t end up saving you much when you can get a meal on the street for $2 USD. Plus, you can’t make pho like the grandma up the road can! - Understand the Money: If, like me, you don’t have a great mathematical brain, use a currency app to help you understand how much you are spending. Knowing the value of the currency will help you avoid being ripped off or spending too much without realising. - Couchsurf: To connect with the locals, try meeting people with Couchsurfing. You’ll get a free place to stay, and you’ll probably make a friend! - Keep it Local: Where possible drink the local beer, eat the local delicacies, and for day trips, try to use local companies. By using local companies you can haggle a bargain price that larger, international tour operators won’t offer. Plus supporting local businesses thrive is awesome! - Hitchhike: I didn’t hitchhike whilst backpacking Vietnam but I have a couple of amigos who have hitched the whole length of the country, no worries. Getting around by hitchhiking is a great way to travel for free, meet local people, and kick plans to the kerb! - Budget-friendly Tours: If you do happen to go on any guided tours, at least make it a tour where you can pay it off in instalments. Global Work and Travel have the broke backpacker in mind with this one. You can even choose the amount per instalment! There are loads of Vietnam tour options to tickle your fancy. Why Should You Travel to Vietnam with a Water Bottle? Whilst there’s a lot that we can do when it comes to travelling responsibly, reducing your plastic consumption is one of the easiest and most impactful things you can do. Don’t buy one-use water bottles, don’t take plastic shopping bags, and forget straws. All of this just ends up in landfills or in the ocean. If you’d like some more tips on how to save the world, be sure to watch the video below. There’s nothing worse than showing up to a picture-perfect beach, only to discover plastic bottles littering the sand. One way to get around this is by investing in a premium filtered travel bottle like the Grayl Geopress. You can filter any kind of water, save money on buying endless plastic bottles – and sleep easy knowing you’re not contributing to the plastic bottles lining our beautiful beaches. Drink water from ANYWHERE. The Grayl Geopress is the market’s leading filtered water bottle protecting your tum from all the waterborne nasties. PLUS, you save money and the environment! Single-use plastic bottles are a MASSIVE threat to marine life. Be a part of the solution and travel with a filter water bottle. We’ve tested the Geopress rigorously from the icy heights of Pakistan to the tropical jungles of Cuba, and the results are in: it WORKS. Buy a Geopress: it’s the last water bottle you’ll ever buy.Buy a Geopress! Read the Review Best Time to Travel to Vietnam Vietnam is a country with multiple weather patterns ranging from monsoon rains, cold snaps, and hot, humid sunny days. It can be hard to catch the whole country at a consistent time of year. But no fret, it is possible! If you are planning to backpack Vietnam from top to bottom, the best time of year generally is September – December (Autumn) and March – April (Spring). These times of the year are your best weather window, where you might be lucky enough to see the whole country in sun! Looking for specifics? Let me break down by regions, the best time of year for backpacking Vietnam: - North Vietnam: October to May will give you dry weather the majority of months. Expect some colder temperatures in the mountains and from March onwards, a little more rain as it gets more humid. - Central Vietnam: February to July is the best time of year to avoid heavy rain. Temperatures will hit the upper 30s in June to August. - Southern Vietnam: December to April is the ‘dry’ season. Temperatures will rarely fall below 20 degrees and will reach up to 40 degrees come March/April. What to Pack for Vietnam Make sure you get your packing for Vietnam right! On every adventure, there are 6 things I never go travelling without: Osprey Aether 70L Backpack Ya can’t go backpacking anywhere without a blasted backpack! Words cannot describe what a friend the Osprey Aether has been to The Broke Backpacker on the road. It’s had a long and illustrious career; Ospreys don’t go down easily. Feathered Friends Swift 20 YF My philosophy is that with an EPIC sleeping bag, you can sleep anywhere. A tent is a nice bonus, but a real sleek sleeping bag means you can roll out anywhere in a and stay warm in a pinch. And the Feathered Friends Swift bag is about as premium as it gets. Grayl Geopress Filtered Bottle Always travel with a water bottle! They save you money and reduce your plastic footprint on our planet. The Grayl Geopress acts as a purifier AND temperature regulator – so you can enjoy a cold red bull, or a hot coffee, no matter where you are. Petzl Actik Core Headlamp Every traveller should have a head torch! A decent head torch could save your life. When you’re camping, hiking, or even if the power just went out, a top-quality headlamp is a MUST. The Petzl Actik Core is an awesome piece of kit because it’s USB chargeable—batteries begone! First Aid Kit Never go off the beaten track (or even on it) without your first aid kit! Cuts, bruises, scrapes, third-degree sunburn: a first aid kit will be able to handle most of these minor situations. With these essentials, I still make sure to do a rundown of my full backpacking packing list. Staying Safe in Vietnam Vietnam is extremely safe for travel. Violent crime is almost nonexistent in Vietnam. Petty crime and pickpocketing can be an issue in the cities however, so just watch your valuables or leave them locked at your hostel. Where backpackers need to be careful is riding a motorcycle. Vietnam’s cities are hectic, and the countryside has windy roads and animals roaming around. Even though road tripping with a motorcycle is a huge part of Vietnam tourism, I don’t recommend this for beginners. Dense cities and tourist attractions are still questionable (as they usually are). Vietnam isn’t rife with petty crime, but keep an eye on your valuables. Past that, Vietnam is pretty standard ‘travel in Southeast Asia’ stuff, and even by that metric, it’s very chill. Stick to the standard advice for safe travel and you’ll be fine. Sex, Drugs, and Rock ‘n’ Roll in Vietnam The penalties for drugs are really harsh in Vietnam, like other neighbouring countries in Southeast Asia. Weed is the most commonly used drug throughout Vietnam, but you will get into a bunch of trouble for having it if you’re caught. Let’s be realistic though, you’re probably going to try drugs on the road. In Vietnam, there are definitely underground scenes amongst locals – especially students – so having local friends helps when looking for a joint. I’d advise against travelling even between cities with anything considered illegal. Once you arrive in a new city, ask around from there. As for sex? Well you’re a backpacker, aren’t you? 😉 Of course, there will likely be a one night stand in your backpacker travels – whether you bone down in a hostel or have a sensuous encounter with a particularly beautiful local. Through it all, you gotta be a good person. Free love is about love as much as it is about sex, y’know? Also, I’d be remiss not to mention ‘sex tourism’. Everything is cheap in Asia, including the services of sex workers. This has led to an industry in Southeast Asia that can be very ethically murky. Regardless of your opinion on sex working in general – and whether or not you engage with sex working services – there is no reason for you to not have respect for another human being. There are enough people in this world with bad intentions and rotten hearts – there’s no need to add your name to that list. But you know that. Travel Insurance for Vietnam Right, now let me be the first to admit that my travels sometimes involve some sketchy activities! But rather than ignore my wild side, I just insure in with World Nomads! That way, I can still have my adventures while knowing if shit hits the fan – I’m covered by insurance. It’s good to get lost sometimes, but it’s also good not to get too lost. There are people that want you home in one piece. There’s one travel insurance provider The Broke Backpacker trusts for all his wildest shenanigans… World Nomads! Click the button below to get a quote on your insurance or read our in-depth review of World Nomads’ coverage. And then… let the shenanigans begin. 😉 How to Get Into Vietnam Vietnam is one of Southeast Asia’s most accessible countries. Whether you are travelling the Southeast Asia loop and entering by land, coming down from China, or flying directly there, border crossings are relatively straight forward and the days of the tricky Vietnamese visa are now over. There are long-distance bus/train services that you can use to get all the way from Bangkok to Ho Chi Minh City, or if you’re feeling more adventurous, train it from Europe all the way to Vietnam… For those backpacking Vietnam without the luxury of time, the best way in is to catch a flight to Ho Chi Minh City. There are flights with the likes of Emirates (via Dubai), Air China (via Guangzhou), and many more Airlines. I’ve found Vietnam Airlines tend to have the best deals for flying direct to Ho Chi Minh City. Most flights will land in Ho Chi Minh but you can fly to other parts of the country. You can enter Vietnam by motorbike easily and you can easily travel from Cambodia across the border to Vietnam using local buses. Or, if you fancy travelling in style, there are VIP bus services available for flash-packers. Entry Requirements for Vietnam Most countries require a visa to enter Vietnam, however, there is a shortlist of countries that are exempt for short stays. Past that, you’ll need to organise a Vietnam e-visa for a 30-day stay. Thankfully e-visas are relatively straightforward to organise before you travel to Vietnam. If you don’t want to organise it yourself, there are many companies out there who can help you apply. And if the 30 days in Vietnam just feels too short, no worries! You can extend once you’re there. Travelling to Vietnam During COVID Times Currently, Vietnam remains mostly closed to tourism. Earlier in 2020, they were keen to begin the reopening process and start the economy kicking over again, but the reopening of borders was delayed, and then indefinitely put on hiatus. While it does not seem likely that Vietnam will reopen its borders to tourism in 2021, they have just recently begun reopening some air corridors with major international Asian business partners. Perhaps in early 2022, we’ll hopefully see some movement. Why stay in a naff hotel when you can stay in a cosy, stylish local house instead? And for half the money too! Stay somewhere EPIC and save your hard-earned dollars — from houses to barns to castles and caves, there is an Airbnb for every occasion!Book an EPIC Stay How to Get Around Vietnam Comfortable long-distance transport and constantly improving road quality make travelling in Vietnam pretty smooth. Vietnam has a great coastal train line that extends up to the Chinese border making travelling onwards to China a snap! It’s a great way to travel across Vietnam on a time limit. Most backpackers choose to explore Vietnam via bus network. Buses in Vietnam are cheap, plenty are hop-on/hop-off style tickets, and they have ever-increasing presence of Air Con. Basically, they are a broke backpackers dream. A great way to get from one end of the country to the other fast and scenically. Vietnam Railways operates a single track train network running from Ho Chi Minh city all the way to the Chinese border with beautiful views of the countryside and coast. Slightly slow in places as much of the train line dates back to the colonial period – but that’s just part of the charm, right? Ensure you book your tickets in advance. Hard sleeper class offers the best value. Be aware that if you buy a through ticket you cannot break up the journey along the way, you will need separate tickets for this. Hop on the Reunification Express for a breathtaking journey. I did not travel via domestic flight within Vietnam. However, if you are on a time limit, a 2hr flight from Ho Chi Minh to Hanoi is a lot more favourable than 30hrs + it can take on the train. Vietnam Airlines, the national carrier, and Jetstar both offer cheap and backpacker-friendly flights to many destinations within Vietnam. Rather than just rocking up at the station in the hope they will have space to fit you on, you can now book tickets in advance for most of Southeast Asia using Bookaway. To kick your backpacking adventure into the next gear, get a motorbike. Travelling by motorbike across Vietnam is often more cost-effective than paying for multiple train/bus tickets. It gives you the freedom to really explore, get off the highway and go in search of raw adventure… Plus you look cool and you don’t have to deal with the drunken Aussie lads on the bus attempting to rope you into a game of ‘drink the beer’. I picked myself up a Honda Win Manual Motorbike second hand from one of the many backpackers selling their bikes in Ho Chi Minh. I paid around $300 and, for the few weeks I had it, only some minor repairs were needed. Before travelling to Vietnam, I had never actually ridden a motorbike before and I was, in truth, a little intimidated. Luckily, riding a motorbike is a lot easier than it looks and after about an hour of (somewhat, hilarious) practice, I was good to go. I had this expectation that the roads in Vietnam were going to be dangerous dirt tracks. But for the most part, they are fairly decent besides a few potholes. The biggest threat to you on the road is your own lack of attention, other drivers and animals/people. Make sure your travel insurance covers you for riding a motorbike in Vietnam. Unfortunately, accidents among travellers are common; I came off my motorbike myself in Dalat and got away with just cuts and bruises… The bike flipped and hit me in the back of the head, and my helmet almost certainly saved my life – always wear a helmet. I’d also consider bringing a dedicated tent for your motorbike if you want to save money on accommodation. I usually rocked up to a restaurant for dinner & politely asked if I could set up there for the night. They always said yes and never charged me a dime. Use Bookaway to find the best deals on transport – buses, planes, trains, and ferries. It’ll save you a load of time when organising transport and you’ll probably nab an EPIC DISCOUNT too! Book your transport on Bookaway NOW. Get the best price for the best ride… then use those savings to buy the best feed in town!Book Your Transport Here! Onwards Travel From Vietnam Vietnam is well placed for onward overland travel to Cambodia, Laos, and China which all border Vietnam. You can bus, motorbike, or hitchhike in a truck full of onions over any of these borders. There are also cheap flights to Thailand, Malaysia, and beyond if you want to carry the Southeast Asia party on that a-ways! If your travel funds are running low, it’s well worth considering a flight Down Under to the famously high minimum wage of Australia! Or, if you want to chill out in some colder climates, why not try backpacking in New Zealand? The long and the short of it is, you’re spoilt for choice when it comes to onwards travel from Vietnam! Working in Vietnam Yes, yes, 1000 times, yes! I have no short number of long-term travelling friends that do a stint working a backpacker job in Vietnam to build up their cash supplies. You will need a work permit to work in Vietnam though. A work permit/visa is valid for up to 2 years (non-renewable) and the pressure of the paperwork is off because the responsibility is on your employer! You’ll need to be sponsored by your prospective employer who will then be responsible for the organisation of your working permit. Vietnam is also an up and coming digital nomad hotspot. It’s got fast internet, a good ex-pat science, and it is ridiculously cheap. There are not many other places in the world where you can get lunch for 2 dollars, and a beer for 80 cents while working with lightning-fast internet. Teaching English in Vietnam Teaching English in Vietnam is one of the most popular forms of work for foreigners in the country. With the right qualifications (i.e. a TEFL certificate), you’ll find a lot of doors opening to you with some decent wages too (relative to the standards of Asia). TEFL courses open up a huge range of opportunities and you can find teaching work all over the world with one! Broke Backpacker readers get a 35% discount on TEFL courses through MyTEFL (simply enter the code BACKPKR). You’ll need a prospective employer to sponsor you (and to go on a contract too). However, then an expat lifestyle in Vietnam awaits! There are heaps of schools around Vietnam that are always looking for fluent English speakers willing to teach. There are even heaps of adults wanting to learn. A lot of people end up working in the major cities (like Hanoi or Ho Chi Minh) simply for the amount of work available and modern lifestyle. Of course, as I always tell people looking to teach English abroad, getting out of the urban jungles and into the villages and rural areas is going to offer a much more authentic and wholesome experience. Volunteering in Vietnam Volunteering abroad is an amazing way to experience a culture whilst helping your host community. There are plenty of different volunteer projects in Vietnam including teaching, construction, agriculture, and pretty much anything. If the regular ol’ day job isn’t beckoning however, volunteering in Vietnam is a spectacular backup choice! You’ll lower your travel costs, connect with local communities, and give back all your best vibes and smiles while you’re at it! If you want to find volunteering opportunities in Vietnam, then we recommend that you signup for Worldpackers – a volunteer platform that connects local hosts directly with travelling volunteers. Whenever you are volunteering, do stay vigilant especially when working with animals or children. Volunteer programs run through reputable work exchange programs like Worldpackers are very well-managed and reputable. Worldpackers: connecting travellers with meaningful travel experiences. Culture in Vietnam Although only surpassed only by Indonesia as Southeast Asia’s most heavily populated country, Vietnam is the region’s most ethnically homogenous country with the Vietnamese making up about 85% of the population. Most of the remaining population in Vietnam is made up of a variety of minority ethnic groups and peoples with their own customs and traditions. Being a communist country, Vietnam has no state religion and atheism is encouraged. In truth, the majority of the Vietnamese people either identify with folk traditions or are just straight atheistic. Buddhism and Catholocism are the other two big religions in the country. Across all beliefs, the family and ancestor worship remain pillar belief concepts. Once you get to know a Vietnamese person, I can guarantee you that you won’t stop laughing. There’s a lot of banter and a kind of humour that’s a second cousin of sarcasm. I don’t know quite how to describe it, but there’s a lot of pointing out the randomness of life and having a good laugh about it. You don’t want to start a friendship with a Vietnamese person with too much banter; you still have to respect that people do not want to lose face. But once you’re out of a formal situation – and after some rice wine has been consumed – then you can unleash the sarcasm! I think this makes sense for a country that had a brutal civil war and then still has to navigate communist “niceties”. When my Vietnamese friend and I went on a bit of a street food bonanza, we joked a lot about things that only made sense in Vietnam – like the couple wearing matching pyjamas while dining at a fancy coffee shop. Also, she found it far too funny that people would stop to take selfies with me because I had blue eyes. Obviously, she had to start calling me “Miss America” despite the fact that I am Australian… Useful Travel Phrases for Vietnam Below I have listed helpful travel phrases for Vietnam. It always pays to learn a new language as you travel to be able to communicate with the locals. At the very least, try! On my first days in Vietnam, the only word I could remember was sorry – sin loi. This was lucky, as it’s something I found myself saying a lot as I tried to navigate the dense city of Ho Chi Minh. Thankfuly, the Vietnamese people are some of the most gracious and good-humoured people on the planet. Nobody cared that I was in the way, although it was pretty funny to hear a little, white foreigner saying sorry over and over! - Hello – Xin Chao - Goodbye – Tam biet - Thank You – Cám on Ban - No Problem – Khong Van De Gi - I like to Eat – Toi Muon An - What is this? – cái si te nài? - I am Sorry – Toi Sin Loi - No plastic bag – Không có túi nh?a - No straw please – Không có r?m, xin vui lòng - No plastic cutlery please – Không có dao nh?a xin vui lòng - I’m Hungry – Tôi Doi - What is your name? – Tên cua ban là si - I don’t understand – Toi khong hieu What to Eat in Vietnam Vietnamese food is popular all around the world! I would be gobsmacked if you have yet to try rice paper rolls or noodle soup. The Vietnamese know how to cook something mouthwatering out of thin air. As well as tasting absolutely wonderful, Vietnamese food is one of the healthiest foods in the world. Prepared with fresh ingredients, vegetables, herbs, and either rice or noodles, each dish is different but delicious! And I will begrudgingly pay the French a complimen: they know how to cook some damn fine food. So, if you can imagine salivating snacks a la Vietnam with just a hint of French influence left over from the colonial days. Yes, the food is the best reason to backpack Vietnam! I remember sitting in a sliver of an alleyway deep within the bowels of the old imperial capital of Hue. I was sweating my sweet tushy off and thought the best way to combat sweat is with sweat, so I proceeded to order the most memorable meal I had in Southeast Asia. Bun Bo Hue. I don’t believe in God, and neither do most Vietnamese people, but how do you explain such divine flavours? While in Vietnam, I would suggest eating out at every opportunity. It’s cheap and delicious. You’ll understand, first hand, why McDonalds has never caught on in Vietnam. Popular Vietnamese Dishes - Buncha – One of my favourites! This is basically a Pork Meatball Noodle Salad. Yum! - Goi Cuon – The famous Vietnamese “Summer Rolls” are a perfect light bite. Normally filled with shrimp and/or pork, herbs and vegetables. They are wrapped in rice paper and served with Peanut dipping sauce. - Pho – Basically noodle soup. There are many varieties of Pho, perfect for those slightly unsure about Vietnamese food. - Banh Mi Thit – Or in other words, the best sandwich in Asia! Basically, a well-sized baguette stuffed with yummy treats such as ham, cheese, fish, vegetables etc. Brief History of Vietnam People have been living in Vietnam for thousands of years. It was one of the first places in the world where rice was cultivated! There were several dynasties that ruled over a unified Vietnam – although alongside this dynasty were many other indigenous groups who never fully assimilated into any dynasty. The Chinese often invaded and were periodically rulers of Vietnam. The Mongols did invade as well but were driven back. When the French showed up in the 19th century though, a unified Vietnam was not willing to be a colony of yet another foreign power. When France was losing in WWII, Japan took advantage and occupied French Indo-China. The Vietnamese Communists or Viet Minh fought the Japanese and by 1945 they controlled parts of North Vietnam. Viet Minh took control of most of Vietnam and declared Vietnam independent by 1945, but France ignored this. With no intention to give up power, fighting broke out between them and the Viet Minh. After a siege lasting 57 days, the French were forced to surrender. In North Vietnam, Ho Chi Minh introduced a Communist regime while in the south Ngo Dinh Diem became ruler. Gradually, the USA became involved in the Vietnam War during the Cold War. First, they were sending military advisers to South Vietnam. Financially, they supported the French and later the South Vietnamese government. Then in 1964 two US ships were supposedly subject to ‘unprovoked’ attacks by the North Vietnamese. The Americans then bombed the north and Congress passed the Tonkin Gulf Resolution allowing the president to take ‘all necessary measures’ to prevent ‘further aggression’. As a result by December 1965, there were 183,000 US soldiers in Vietnam and by the end of 1967, there were nearly half a million. However, the Vietcong continued their guerrilla war. Americans withdrew from Vietnam in 1973, but the South Vietnamese continued to fight the Vietcong alone until 1975 until the North Vietnamese captured Saigon. Vietnam was reunited under Communist rule. FAQs About Backpacking Vietnam Every first time backpacker to Vietnam has a few questions that they are dying to know! Luckily, we’ve got you covered… This book is the ULTIMATE culmination of more than 10 years of travel experience. It’s full of valuable insider hacks and secrets that will help you unlock your full potential as a traveller. AND… it’s also FREE at the moment! All you need to do is click this link (or the sexy image of Will flexing his handstand skillz), provide your email, and we’ll email you the ebook lickety-split! Final Advice Before Visiting Vietnam Be good to Vietnam. Writing your name in black marker on temples, chugging beer in Saigon while shirtless, swearing loudly, and visiting unethical animal attractions? You, Sir, are a twat. Luckily, most backpackers don’t fall into this category but, when you’re out and about and have had a few too many drinks, it can be easy to embarrass yourself. By no means am I telling you not to drink, smoke, or party. Do it and enjoy it. Just don’t get so drunk you turn into an imbecile your mum would be ashamed of. Go to Vietnam and have the time of your life, but be respectful along the way. There are mountains to hike, cities to explore, and some delicious bun bo hue to try along the way. You are sure to experience a very special slice of the world when you travel to Vietnam. When we travel, we make choices that not only impact ourselves but the local communities around us and the travellers that come after us. When we are privileged enough to experience a country like Vietnam, it’s up to us to make sure it stays special for those that come after us. Vietnam has had it rough over the years. Just be good to it, is all. Now all that’s left is for you to book your ticket and get trying that banh mi! Updated November 2021 by Indigo Atkinson. Thanks for reading – that was fun! 😀 We bring you epic FREE content! Find out how YOU can help support us. We’re a big site with a big team and this job isn’t always easy. But we do it because we love it – we love providing epic and free content. We love the knowledge that our content keeps you adventuring. We don’t ask for money, but if you’d like to find out how you can help the site in more organic ways, click the button below. Thank you for your support 🙂 Bye for now, but not forever! If you want MORE top-tier Broke Backpacker content like this, then sign up for our weekly newsletter below to get the latest and greatest! And for transparency’s sake, please know that some of the links in our content are affiliate links. That means that if you book your accommodation, buy your gear, or sort your insurance through our link, we earn a small commission (at no extra cost to you). That said, we only link to the gear we trust and never recommend services we don’t believe are up to scratch. Again, thank you!

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Exactly a year to the day he claimed his course record in the Alfred Dunhill Links Championship, Tommy Fleetwood returns to Carnoustie having ended his Ryder Cup hangover in abrupt fashion at Kingsbarns yesterday. It looked like a right good one at three-over after 10, in tricky conditions on the course you’re supposed to make hay on in this format, although steady winds of 20 mph gusting to 30 mph made it incredibly tricky yesterday. But Fleetwood recovered his composure in fine style with four birdies the rest of the way, a 71 which lies just three off the lead shared by Australia’s Marcus Fraser, who shot a 68 at Carnoustie, and Matt Wallace of England, aiming for a fourth win on tour this year, who shot 68 on the Old Course. There’s a fine spread of players on three-under, including the now veteran Irishmen Paul McGinley, playing better than he did in the very different conditions of the Senior Open in July, and – if you believe what’s being widely whispered – the next Ryder Cup captain-elect Padraig Harrington. Tyrrell Hatton (70), going for a third successive Dunhill Links title, and Brooks Koepka (70) are not far off the lead. Best placed Scot is Stephen Gallacher after a one-under 71 at Kingsbarns, with Connor Syme next best after a par round of 72 on the Old Course. “It’s nice to get a start like that and still beat the golf course,” said Fleetwood. “It’s kind of a little goal I had in mind. “It was always going to be tough (to get back), but even at 3 over, I thought it’s still a chance if you hit good shots. “Just see what the weather brings, really, but we’ve got to play two courses that I really like. “The wind can do funny things to your swing. But I’ve been swinging well and hopefully tomorrow I can go out and make some birdies and continue on the momentum.” Kingsbarns is different from the other two courses even in a strong wind, pointed out Fleetwood. “St Andrews you go out with one wind and come back with another. Carnoustie is probably not the nicest to play in gale force winds,” he continued. “Here, everything is so open. A lot of the greens are raised. If you get Kingsbarns on a lovely, calm day, it’s like such a lovely place to play because you really can get a score. Today was just a grind.” The wind was certainly no easier at Carnoustie, which made Fraser’s 68 – one of only five rounds par or better on this year’s Open links – the probable round of the day. He had only one dropped shot, at the fourth, and got his birdies at the long holes on the back nine – the 12th plays as a par five in this format, and it was a par four in July – and the bonus was a 30 foot birdie putt rattling in at the 16th. “I just sort of stuck it out most of the day, waited for the putts to drop and at the end I made a couple of good par saves,” said the 40-year-old, who last won two years ago in Malaysia. “It’s brutal out there, that’s as strong as I’ve played the golf course, I think.” “You’ve got to go out and just keep it in play, and you’re going to get rewarded. On Carnoustie, it’s hard to keep it in play sometimes, but you’ve got to try and avoid those bunkers, and luckily enough I avoided all of them apart from one.” Wallace, who was overlooked for a wildcard for the Ryder Cup despite his three wins this year, would certainly make some sort of statement by winning here this week. Playing at St Andrews, he burst to life with four birdies in five holes from the fifth, and picked up another the last to complete his 68. Harrington’s 69 came after he barely hit balls last week while on vice-captain duties at Le Golf National, and he admitted to being “pleasantly surprised”. “I thought I would never be ready for today, but there you go, a bit of focus, being in competition sharpens you a little bit.” Back to Carnoustie today, but even Harrington, with two Dunhills and an Open under his belt there, doesn’t feel he can relax. “I have good history there and it’s nice for me to go back, but Carnoustie is a tough golf course,” he said. “I for one always go into Carnoustie with a bit of trepidation. Just because I’ve won there, doesn’t mean I’m going to breathe easy around there tomorrow.” Gallacher, playing at Kingbarns, suffered two double bogeys at the sixth and 15th but five birdes as well. At 90th on the race to Dubai, he’s the home-based player with the least to fear about retaining his tour rights, but a good finish here could move him up into the big-earning end of season events. For Syme, on home ground, a finish like last year’s tie for 15th on an invitation would do wonders for his prospects for staying inside the top 110 who retain their cards. A solid 72 in the testing conditions, crowned by a birdie three on the last, put him in decent shape. Richie Ramsay, David Drysdale and invitee Sam Locke all had opening one-over-par 73s.

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In line with celebrating women, these leggings are named after the Goddess of Battle, Zaria. Suitable for our hot and humid weather, these leggings stay cool on the skin through your sweatiest workouts and are quick-drying! We are proud to have tweaked the waistband to ensure that sliding down is kept at a minimum with newly tapered sides and higher hip seams(they're supposed to sit above the hip bones). The devil’s always in the details: ⁃ Brand new tapered waistbands to prevent sliding down ⁃ V-front seams for an illusion of a smaller waist ⁃ Higher hip seams that sculpt the booty - meant to sit above the hip bones ⁃ Laser-cut details around the ankles ⁃ Signature no front seam = zero camel toe issues! Features: ⁃ Ultra-soft 4way stretch nylon - zero restrictions ⁃ Cool to the touch with a second-skin feel ⁃ New rubberized logotype Jane wears size XS. Height: 170cm, Waist: 26.5", Hips: 33". Leggings Sizing & Fit: They are high-waisted, with the seams sitting high above the hip bones. No dig waistbands to ensure a smooth comfortable fit. Waistbands are about 0.5" smaller but hips are still the same as all our leggings. Please stick to your usual sizing. Jane usually wears a Small in our leggings but have sized down in these for a more snug fit. Sizing is still subjective to each individual's preference. Measurements listed are a rough guide, please kindly approach us if you're unsure of your sizing. Local delivery - $5 Free shipping is offered at orders above $80. All orders will be tracked. Self collection - Free - Oompf GX, 180 East Coast road International delivery - International orders above 200SGD is free* For international orders below $200, delivery fees will be as follows: Malaysia, Indonesia - $10 Taiwan, Hong Kong, Philippines and Thailand - $15 Australia, China, Japan, Korea, Vietnam, Brunei and Cambodia - $20 United Kingdom, United States, Canada, New Zealand - $30 Other countries not stated: $35 *Free shipping above 200SGD is only offered to countries in Malaysia, Indonesia, Taiwan, Hong Kong, Philiphines and Thailand.

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“In Geneva 2, we must make sure that... all the measures will not fail...so that we can (bring) in an era without Bashar al-Assad,” he said, referring to peace talks planned later this month in Switzerland. The Syrian conflict is estimated to have claimed more than 130,000 lives, and has forced millions more to flee their homes. “A person who has allowed that to happen still remaining at the top of the country cannot be accepted,” Erdogan said. UN Secretary General Ban Ki-moon has started sending out invitations to the so-called Geneva 2 peace talks, but Assad’s key ally Iran was not on the first list, UN deputy spokesman Farhan Haq said. That could help pave the way for the opposition National Coalition, which has repeatedly stipulated that Iran must not be invited, to participate. The 30 countries invited to the Geneva talks include Saudi Arabia, a major backer of the Syrian opposition, as well as the five UN Security Council permanent members -- and Syria’s neighbours Turkey, Iraq and Jordan. Japanese Foreign Minister Fumio Kishida is also expected to attend. “In the Geneva 1 there were several issues that were taken up and in the Geneva 2 we will make sure that these will not fail.... It is very important that Japan takes part in this,” Erdogan said. The Coalition, which re-elected Ahmad Jarba as its leader on Sunday, will discuss Tuesday whether to attend the talks, although a key group -- the Syrian National Council -- has already announced a boycott. US Secretary of State John Kerry and Russian Foreign Minister Sergei Lavrov will meet on January 13 in a bid to decide Iran’s role in ending the nearly three-year-old war, said Haq. Erdogan is on a three-day visit to Japan, with more than 100 business officials, aimed at boosting economic ties with Tokyo. He will also visit Malaysia and Singapore. He was speaking at lecture hosted by the Nikkei newspaper and the Turkish embassy in Japan, and did not address the current political machinations at home, where a corruption and bribery investigation has shaken his pro-business government.

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Apparently Datuk Syed Alman Syed Alwi went to a Zahid Hamidi family dental practice to have some loose teeth rectified after SOMEONE Punched him several times in the face. Some reliable sources in the clinic have said they saw bruised face and black eye. Neighbours of Datuk Nurulhidayah...the eldest daughter of Zahid Hamidi said a heated argument occured before Zahid Hamidi arrived. In the resulting argument some shouts were heard and Talak 3 was also shouted apparently from Datuk Syed Alman Syed Alwi the deceased. Talak -3 to those of Non-Muslim upbriging is the words that a male muslim can sms, recite, shout out to DIVORCE His Wife immediately!! That is the sickness of the UMNO-PAS-Hudud IS Islam Religion with approval from the Sultan-Agong-Govenor of Malaysia. Rumours said Autopsy on the body have identified some Botulinum toxin the blood system but the unnamed pathologist was not allowed to specify that Datuk Syed Alman Syed Alwi died a mysterious death!! Just imagine the amount of money that Zahid Hamidi and his daughter Datuk Nurulhidayah would lose if Datuk Syed Alman Syed Alwi was to carried out his acts. no one wants the problem to be dragged out like the Taib Son Datuk Seri Mahmud Abu Bekir Abdul Taib had to do in his divorce being dragged for the public to see. A DPM on the verge of becoming a prime minister must eliminate all HINDERANCE like Rosmah & Najib did on Altantuya using Sirul UTK C4 Explosive expert all with tthe Approval of Sultan-agong-Govenor Defender of IS ISlam Racist terrorist UMNO Malays Sect!! This DPM is a Minister of Home Affairs. Also known as Gestapo, Kempetai....the ISA put you in lockup WITHOUT Proper legal justification. So why the Hell when your son-in law died as home minister need to go to Japan apart from avoiding the obvious scrutiny??? Which dentist or medical doctor dare to speak up against ACTS of Violence from a minister that have a history of Vilonce like the previous Sultan of Johor..Sultan Ismail caddy boy Killer?? Seems like some kind of Legal Proceeding is being conjured up in the courts now and as long as the Dentist Play along with the game .... those Millions dollars back room hand shake will make this MURDER CASE by Zahid Hamidi a close case like the bashing he gave to his daughter ex-boyfriend...Play out as some sort of Sudden Death and case close..>Dental Practice can continue!!.....Just like the last Sultan of Johor Murdered the gold caddy on the golf course and DO MALAYSIAN REALLY THINK THE CURRENT SULTAN OF JOHOR IS GOING TO CONDEMN THESE SENSELESS MURDER TO JEOPARDISE THEIR POSITION AS RESPECTED MALAY RULERS??? The Billions of $$$$, money , power position cannot be ruined by a Divorce with knowledge of the Zahid Hamidi ILLEGAL Dealings...corruption...1MDB transfer to take Heat away from Najib..... This Zahid Hamidi Bastard now wants to control the Kidnapping Money in Sabah/Sarawak and all over Malaysia...in the Millions Ringgit again $$$$$... More to follow!!! The Doctor will need to subpoena the parents and siblings, exhume body for toxin, friends of Syed Alman Syed Alwi to determine if ANY Discussion of Wanting a Divorce with Zahid Hamidi's daughter was EVER mentioned and discussed!! IF there was then this Murder by Zahid Hamidi makes sense like the case of Najib-Rosmah instructing UTK to Kill Altantuya in order to become the Crime Minister of Malaysia!! Then again all can be paid millions to make it look a Legit Death...like the legit Divorce and case of Nika Gee, Stanley and Muhiddin.....like Saiful who saw Najib for Anwar sodomy case....All these people are on Death Watch!! This is the same daughter that somehow a Malay sultan -agong awarded her some titles at a young age and also insulting Malaysian Malays that they are too choosy in doing 3-D jobs..... Dirty...degrading and dangerous jobs while she sits on her PAPA hundreds of hidden company business as director collecting free money!! She now trying to control the black market of Vape electronic cigarettes market via some dogdy deals with the Perkasa, 3 Line UMNO Malays IS Islam terrorist groups.. Datuk Nurulhidayah is also the same person that Insulted those on BERSIH 4.0 Rally as Stupid and pointless. She further added that if you want to defend the country democracy go join the army and patrol the country borders and security.... She is also the central figure of an ongoing legal Thuggery by her father Zahid Hamidi agaisnt Amir Bazil Abdullah..that seems to go no where in the Malaysian courts. Simply because he was not as wealthy as Zahid hamidi wanted his daughter to marry. Lucky him...he is still alive....get out of Malaysia if you can. The same ongoing Legal Thuggery the Courts are doing to M Indira Gandhi hasn't held her daughter in her arms since her ex-husband snatched the then 11-month-old baby from the family home seven years ago.

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Established : 2012 Headquarter : It doesn't have headquarter Countries in East Asia region have thriving trade and economic relations with each other through free trade agreements. The Association of Southeast Asian Nations (ASEAN) has Free trade agreement(FTA) with six partners namely China, South Korea, Japan, India, Australia and New Zealand. In order to broaden and deepen the engagement among parties and to enhance parties’ participation in economic development of the region, the leaders of 16 participating countries established the Regional Comprehensive Economic Partnership (RCEP). The RCEP was built upon the existing ASEAN+6 with the spirit to strengthen economic linkages and to enhance trade and investment related activities as well as to contribute to minimising development gap among the parties. In 2012, the 16 Economic Ministers endorsed the Guiding Principles and Objectives for Negotiating the Regional Comprehensive Economic Partnership. The RCEP negotiations were launched by Leaders from 10 ASEAN Member States (Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam) and six ASEAN Free trade agreement(FTA) partners (Australia, People’s Republic of China, India, Japan, Republic of Korea, and New Zealand) during the 21st ASEAN Summit in Phnom Penh, Cambodia in 2012. The objective of launching RCEP negotiations is to achieve a modern, comprehensive, high-quality, and mutually beneficial economic partnership agreement among the ASEAN Member States and ASEAN’s Free trade agreement(FTA) partners. The RCEP negotiation includes: trade in goods, trade in services, investment, economic and technical cooperation, intellectual property, competition, dispute settlement, e-commerce, small and medium enterprises (SMEs) and other issues.

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On May 12, a Tibet Airlines Airbus A319 performing the Chinese domestic flight TV9833 from Chongqing to Linzhi skidded off… Ukraine: The Ongoing Conflict’s Effects on the Aviation Industry The situation on the border between Ukraine and Russia has always been very tense. To better comprehend the reasons for this war, it is necessary to understand the events of recent years. The first problems in Ukraine began with the series of violent demonstrations called “Euromaidan” on the night of Nov. 21-22, 2013, in the main square of Kyiv. These protests erupted after Ukrainian President Janukovyč postponed the signing of the Political and Economic Association Agreement between Ukraine and the European Union (which later came into force in 2017) under heavy economic pressure from Russia. The Ukrainian president had reached an agreement with Putin under which Russia would buy $15 billion of Ukrainian bonds, and discount the price of gas by a third. During the protests, on November 30, 2013, following the attack of government forces against the demonstrators there was an escalation of violence, leading to the Ukrainian revolution the following year, culminating in the ouster of President Janukovyč. Following this government crisis, the situation of Crimea, a peninsula facing the Black Sea, broke out. After the collapse of the Soviet Union in December 1991, Crimea proclaimed self-government on May 5, 1992, but later agreed to remain within Ukraine as an independent autonomous republic. However, the region, whose majority is ethnic Russian, was militarily occupied by Russian troops in 2014 and through a referendum (defined as illegal by the UN, European Union, United States of America, and Ukraine itself) was annexed to the Russian Federation. Then in May 2014, there was a referendum on the independence of the Donbas region, in the Donec basin, a river on the border between Ukraine and Russia. The referendum, organized by pro-Russian Ukrainian separatists was strongly criticized by the central government of Ukraine, the United States and the European Union, having reported strong electoral fraud and military repression. The only state to recognize the referendum was Russia. Therefore, part of the Donbas region unilaterally declared itself independent from Ukraine in 2014. Then in July 2014, Malaysia Airlines Flight 17 flying from Amsterdam to Kuala Lumpur was shot down by a surface-to-air missile (a system at that time employed by both Russian and Ukrainian armed forces) while flying over the eastern part of Ukraine, killing the 298 people on board (283 passengers and the 15 crew members). Responsibility for this downing is still not well defined, but preliminary conclusions state that flight MH17 was shot down by a surface-to-air missile via a system (probably arrived from Russia and then sent back to hide the evidence of its presence) that originated from a farm in an area controlled at the time by pro-Russian Ukrainian separatists. Recent Developments and the Donbas War The 2014 referendum on the independence of the Donbas region was recognized only by the Russian Federation, and on Feb. 21, 2022, Russian President Vladimir Putin officially recognized it as Russian territory. Therefore, on the night of Feb. 23-24, the Russian president gave the order to attack, explaining that he had authorized “a special operation” in Ukraine to “demilitarize the country” and “protect the Donbas region” effectively beginning the Russian invasion of Ukraine. Less than 20 minutes after the attack began, Eurocontrol, the continent’s intergovernmental civil-military air traffic control organization, said that as a conflict zone, the airspace of Ukraine, Russia and Belarus within 100 nautical miles of the borders with Ukraine could be dangerous to fly over, avoiding the risk of civilian aircraft being misidentified and subsequently shot down again as with 2014’s Flight MH17. Shortly afterward in addition to Ukraine, the airspace of neighboring Moldova was also closed. The local airline, Ukraine International Airlines, has announced the suspension of all flights, while the low-cost airlines Ryanair and Wizz Air have announced the suspension of flights to Ukraine for at least the next two weeks. In response to the military invasion of Ukraine, the United Kingdom has banned all Russian aircraft from flying in British airspace, as have the Czech Republic, Bulgaria, Poland, Romania, Slovenia, Lithuania, Latvia and Estonia. Estonia’s prime minister, Kaja Kallas, urged all European nations to do the same, saying that “there is no place for the aggressor state’s planes in Europe’s democratic skies.” Russia promptly responded with bans on flights by the airlines of the United Kingdom, Poland, the Czech Republic, Romania, Bulgaria, Estonia, Latvia, Slovenia, Germany, Italy, Iceland, Austria, the Netherlands and Malta The closure of air traffic over Ukraine however further reduces the corridors of airlines flying between Europe and Asia. Already in the past months, airlines have tried to avoid Belarusian airspace by flying to Turkey or further north to the Baltic States and Finland. All this after the hijacking in Minsk of a Ryanair Athens-Vilnius flight, actually hijacked only to arrest an activist and his girlfriend on board. In the event of a complete diplomatic breakup between the West and Russia, Putin could order no aircraft (civilian or cargo) to pass over his country. This would have serious repercussions, forcing companies to further lengthen routes with higher kerosene consumption. - Emirates Nearly Tripled Passenger Tally, Doubled Revenue in 2021-2022 Year - May 15, 2022 - ITA Airways Participates In SkyTeam Sustainable Flight Challenge - May 8, 2022 - ITA Airways Focuses on Urban Air Mobility - May 1, 2022 United Airlines said on Tuesday that the Federal Aviation Administration has cleared 52 of United’s Boeing 777-200 aircraft operating with… On Monday, JetBlue set in motion a second attempt to merge with Spirit — the ultra-low-cost carrier — through the…

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Hello and welcome to the details of Non-essential travel ‘strongly discouraged’, says EU chief and now with the details BRUSSELS, Jan 22 — EU leaders agreed yesterday to consider restricting non-essential trips across the bloc’s internal borders to contain the spread of the coronavirus, Brussels’ top officials said. “All non-essential travel should be strongly discouraged both within the country and of course across borders,” European Commission president Ursula von der Leyen said. Freight transport should continue but EU Council chief Charles Michel said, “in terms of non-essential movements restrictions should be possible to consider”. Speaking after a video summit of all 27 EU leaders, both officials stressed that the operation of the single market and trips by essential cross-border workers must be protected. But, asked why member states did not simply ban leisure travel, Michel confirmed “it will probably be necessary to take additional restrictive measures in order to limit non-essential travel.” “In the next hours and days, we will work again in order to coordinate, in order to cooperate based on common sense, based on the idea that it’s important to limit the spread of the virus,” he said. Under EU rules border security and health policy are matters for member states. While some capitals have called for tighter travel controls, Brussels wants to play a coordinating role. — AFP These were the details of the news Non-essential travel ‘strongly discouraged’, says EU chief for this day. We hope that we have succeeded by giving you the full details and information. To follow all our news, you can subscribe to the alerts system or to one of our different systems to provide you with all that is new. It is also worth noting that the original news has been published and is available at Malay Mail and the editorial team at AlKhaleej Today has confirmed it and it has been modified, and it may have been completely transferred or quoted from it and you can read and follow this news from its main source.

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CMI programme at Edge Hill helps build stronger team at Pakawaste - Author Don Fryer - Published July 28, 2021 - Word count 571 “As our business continues to grow, offering new products into new sectors, it is important that the team expand their management knowledge and skills to build their confidence and feel valued and supported. The CMI programme at Edge Hill has helped us to build a stronger more coherent team that will stay with us for a long-time to continue to move the business forward. The content of the Level 7 course has been informative and applicable to my role as CEO. John Plummer from the Business School at Edge Hill has made the course engaging, interactive and enjoyable.” – David Hamer, CEO – Pakawaste Limited CMI Management and Leadership Qualifications – benefits and impact • Build a strong coherent management team • Expand management knowledge and capabilities • Formalise management experience with a professional qualification • Develop a confident and loyal workforce to help grow the business About the business Preston based Pakawaste Ltd is the UK’s number one waste handling equipment and systems provider. They offer a wide range of products to a variety of sectors including retail, manufacturing, warehousing, education, transport and leisure/entertainment. The forward-thinking organisation was established forty-five years ago. They have built a reputation for providing tailored flexible design that puts customer service at the forefront of their operations. CEO, David Hamer has been with the organisation for fifteen years and along with his experienced team has helped shape the business into the success it is today. With plans to expand into international markets including Australia and Malaysia, the company currently employs over 75 local people, making it one of the largest employers within its field in the UK. Building leadership and management capabilities David has built an organisational culture that has its employees at the centre of all they do. Training and development play an integral role in the success of the business. Providing better opportunities to the employees and personal development is encouraged and supported. The organisation has an established technical apprenticeship programme up to degree level and leadership and management training is highly valued. The range of qualifications offered through the CMI management and leadership programme by Edge Hill was not only a perfect opportunity for David to offer the online courses to his employees, but for him to continue with his own personal development. David has completed his Level 7 Strategic Management and Leadership certificate and four members of his Sales, Service and General Management teams are studying one of the CMI nationally recognised qualifications. Outcome and impact Rachael Almond joined Pakawaste as a Maintenance Administrator and before long was promoted to Maintenance Manager. Studying the Level 4 Management and Leadership, Rachael has found the knowledge-based programme beneficial and has been able to apply her learning to her role. The course has helped her build the confidence to view her own performance within the team and adapt different techniques to support her in her approach to tasks and situations. The online delivery of the programme has provided David and his team with the flexibility to adapt the course around their busy work and home schedules and all the team have been given the time to access the live lectures. Whilst on the course, David has been announced as the winner of the prestigious Global 100 – Europe CEO of the year 2021 award. Winners of the award need to have demonstrated exemplary leadership and team management in their domestic and international work. Congratulations to David, from John Plummer and the team at the Business School. There are no posted comments. - The role of small and medium enterprises on the country's economy - 6 Resources for Leadership Development - 6 Benefits of Doing Business in the United Kingdom - 9 tips for digital transformation success - Creating Psychological Safety through structure and human interaction - Tips for Establishing Trust as a Leader - Why has Network Security Become Essential for Businesses? - Active Listening: Do You Listen to Reply or to Understand? - 5 Ways To Create A Positive Workplace Culture - 5 Ways You Should Be Using Digital Signage in the Workplace - Organization Development - The world is in chaos: How to lead in times of uncertainty? - 5 Great Ways To Foster A Positive Workplace Culture - Why I am successful in the male dominated industry of solar - How to fill your PMP application form like a pro? 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Business News›Saint Gobain India SAINT GOBAIN INDIA Sembcorp to supply 33 MW renewable power to Saint-Gobain for 25 years The power to Saint-Gobain’s manufacturing facilities will be supplied through a special purpose vehicle (SPV). GIWEL will hold a 74% stake in the SPV, with the remaining stake held by Saint-Gobain India. Sembcorp to supply renewable power to Saint-Gobain for 25 years "Saint-Gobain India and Sembcorp Green Infra's (SGIL) subsidiary Green Infra Wind Energy Ltd (GIWEL) have partnered to sign a long-term wind-solar hybrid energy supply agreement," it said in a statement. M&M signs pact with IIT Madras-incubated entity to launch campers in India These will be developed with assistance from IIT Madras Advanced Manufacturing Technology Development Centre (AMTDC), International Centre for Clean Water (ICCW) for water management and waste disposal solutions and Saint Gobain Research Centre for their expertise in glazed solutions. IIT-M Research Park, Saint-Gobain India sign MoU on renewable energy The objective of the partnership is to focus on addressing the energy challenges and promote maximum use of alternate energy sources. With a strong focus to develop sustainable models and ensure energy efficiency, IIT-M Research Park intends to create a robust energy storage mechanism within campus. Biggest gainers & losers of the day: MapmyIndia off to firm start; Latent View tanks 8% Arijit Malakar, Head Research (Retail), Ashika Stock Broking said the market is expected to remain weak amid concerns over the new coronavirus strain which could derail the global economic recovery and probable interest rate hike in developed economies sooner than expected. India starts probe into alleged dumping of electrogalvanized steel from Korea, Japan, SingaporeThe directorate, under the Commerce Ministry, will see whether the product is being dumped by firms of these nations in India and if it is impacting the domestic industry. Saint-Gobain eyes up to Rs 1,000 crore revenue from housing solutions business in 3 to 5 yearsSaint-Gobain India through the concept brand of "MyHome" is offering solutions to customers for products including windows, shower cubicles, ceilings, kitchen and wardrobe shutters, roofing products and mirrors. As states unlock, companies still unsure of calling back staffKPMG, too, will take a call on bringing back employees to offices only next month. Executives at Nestle, Dabur, Capgemini, PepsiCo India, Publicis Sapient, Genpact, American Express and Kimberly-Clark India also told ET that they would continue with work from home for now for the office staff. These non-healthcare stocks can make the most of vaccination drive: Watch out!An estimate by Crisil Ratings says sharp increase in Covid-19 vaccination-led pharma demand and expected healthy growth in end-user sectors like automobiles and construction is expected to drive up revenues by 12 per cent year-on-year for domestic glass makers in financial year 2022. Up 40% in 6 days! This midcap is on fire through rain or shine. Red flag goes upPost earnings update, a few brokerages have upgraded the company’s earnings estimates by about 20 percentage points each for FY22 and FY23, and also upped price targets for the stock, believing it deserves a premium valuation. Saint Gobain India eyes Rs 20,000 crore annual revenue by 2028The company’s revenue for the quarter to March 2021 grew 18% compared to the same period in 2019, according to Santhanam B, chairman and managing director, Saint-Gobain India. Santhanam expects the current surge in Covid-19 infections in India to make a dent in the business but said that it will only be a short-term blip. Real estate ancillary industries expected to reach the pre-Covid sales level“With the demand for housing going up, the materials have to keep pace with the demand. Our target is G+4 buildings and as per our estimate the market for low rise is Rs 34,000 crore in Delhi-NCR alone,” said Amit Garg, CEO-Hippo Stores, from the house of Dalmia Bharat Group. NSE-BSE bulk deals: Plutus Wealth buys Saint Gobain stake; BoB sells Rolta IndiaPrior to today’s stake buy, Plutus Wealth held 4.93 per cent stake in the company, according to the latest shareholding data. India may impose countervailing duty on Clear Float Glass imported from MalaysiaIn the notification, the authority said that the domestic industry has submitted that it is currently going through a deep crisis due to the prolonged lockdown in India. Saint-Gobain Sekurit Q4 results: Profit down 41.7% at Rs 2.44 croreSaint-Gobain Sekurit total expenses were at Rs 24.29 crore. Government initiates anti-dumping probe into imports of clear float glass from MalaysiaA complaint by Indian companies has resulted in the government probing imports of glass from Malaysia. French glassmaker Saint-Gobain unveils investments at Chennai facilitySaint-Gobain's global revenues crossed Euro 40.8 billion in 2017. It is present in in 67 countries, runs 945 production sites, and employs over 179,000 employees. French companies seek long term ties: AmbassadorFrench companies are committed to investing and innovating in India and they appreciate the huge opportunities offered by the country: its incomparable talent pool and its promising market, the French ambassador said. Wabi Sabi, designer ceilings, and more: The decor trends your home needsMulti-functional furniture and drywalls are also a big hit these days. India’s growth picture is as clear as glass for Saint Gobain“India is one of the fastest growing countries for Saint Gobain. India is the number one country for us — even more than China,” Saint-Gobain Group chairman said. From the fifth wall to gypsum-based partitions, home design trends that will rule 2018A handy guide for re-doing your home. This Diwali brighten your home with designer ceilingsDon't let the decor be limited to the walls! 10 stocks from not-in-focus sectors surged up to 1,500% in 3 years; do you own any?Select stocks from neglected sectors like glass, aquaculture, hydraulics and LPG bottling sectors rallied up to 1,570 per cent in the past 3 years till date. Twenty three stocks in focus on Wednesday, 02 November 2016Domestic equity markets are likely open lower on Wednesday tracking Nifty futures on the Singapore Stock Exchange (SGX Nifty) and weak global cues. Saint-Gobain invests Rs 1,000 crore more in Tamil NaduThe company may set up a small solar farm at the plant or go for third-party purchase. Saint-Gobain is currently purchasing sand from global sites such as Egypt. Saint Gobain to further invest Rs 1,000 crore in Tamil NaduThis investment will be used for setting up its third float glass plant and new magnetron coater plant at Sriperumbudur.Load More BACK TO TOP

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Allmania nodiflora var. procumbens Hook. fil., Fl. Malay Penins. 3: 4 1924.; India (S-India) as per Catalogue of Life; 4 varieties of Allmania nodiflora : 1 correct image as above. 5 posts by 3 authors. I wish to share all the varieties of Allmania that I have collected. Allmania nodiflora var. aspera (Roth) Hook.f.1.jpg Allmania nodiflora var. nodiflora 2.jpg allmania nodiflora var. procumbens 3.jpg Allmania longipedunculata (Trimen) Gamble5.jpg Allamania nodiflora var. roxburghii 4.jpg Excellent work, …! Thanks for sharing some of the not-so-common varieties/forms of Allmania. I only collected var. dichotoma, var. nodiflora, and A. longipedunculata from Tamil Nadu. Thanks again for sharing the pictures. Wonderful work, … Thank you, …, My ambition is to record all our native plants with photographs, since they are most useful and easy tools to know our wealth; this a small step in this journey, UGC India has sanctioned me a project for digitalising the florstic resources of Velugonda hills of E.ghats; the native place of Pterocarpus santalinus, Boswellia ovalifoliolata, Decalepis hamiltonii, etc., I am recording almost all parts of a plant in photographs. I am really astonished sometimes, and enjoying the work. JSGamble is my role-model. Thanks, …, Best wishes in your wonderful journey!!! As per keys in the book in the link of Flora of Karnataka, your posted image of Allmania nodiflora var. procumbens may be of Allmania nodiflora var. dichotoma (Heyne) Hook. fil.

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Location in Turkey |Coordinates: 41°00′49″N 28°57′18″E / 41.01361°N 28.95500°E| |Founded as Byzantium||c. 660 BCE| |- Per capita||$22,765| Istanbul (// or // or //; Turkish: İstanbul [isˈtɑnbuɫ]), historically known as Constantinople and Byzantium, is the most populous city in Turkey and the country's economic, cultural, and historic center. Istanbul is a transcontinental city in Eurasia, straddling the Bosphorus strait (which separates Europe and Asia) between the Sea of Marmara and the Black Sea. Its commercial and historical center lies on the European side and about a third of its population lives on the Asian side. The city is the administrative center of the Istanbul Metropolitan Municipality (coterminous with Istanbul Province), both hosting a population of around 14.7 million residents. Istanbul is one of the world's most populous cities and ranks as the world's 7th-largest city proper and the largest European city. Founded under the name of Byzantium on the Sarayburnu promontory around 660 BCE, the city developed to become one of the most significant in history. After its reestablishment as Constantinople in 330 CE, it served as an imperial capital for almost 16 centuries, during the Roman and Byzantine (330–1204 and 1261–1453), the Latin (1204–1261), and the Ottoman (1453–1922) empires. It was instrumental in the advancement of Christianity during Roman and Byzantine times, before the Ottomans conquered the city in 1453 and transformed it into an Islamic stronghold and the seat of the Ottoman Caliphate. Istanbul's strategic position on the historic Silk Road, rail networks to Europe and the Middle East, and the only sea route between the Black Sea and the Mediterranean have produced a cosmopolitan populace, although less so since the establishment of the Turkish Republic in 1923. Overlooked for the new capital Ankara during the interwar period, the city has since regained much of its prominence. The population of the city has increased tenfold since the 1950s, as migrants from across Anatolia have moved in and city limits have expanded to accommodate them. Arts, music, film, and cultural festivals were established at the end of the 20th century and continue to be hosted by the city today. Infrastructure improvements have produced a complex transportation network. Approximately 12.56 million foreign visitors arrived in Istanbul in 2015, five years after it was named a European Capital of Culture, making the city the world's fifth most popular tourist destination. The city's biggest attraction is its historic center, partially listed as a UNESCO World Heritage Site, and its cultural and entertainment hub can be found across the city's natural harbor, the Golden Horn, in the Beyoğlu district. Considered a global city, Istanbul has one of the fastest-growing metropolitan economies in the world. It hosts the headquarters of many Turkish companies and media outlets and accounts for more than a quarter of the country's gross domestic product. Hoping to capitalize on its revitalization and rapid expansion, Istanbul has bid for the Summer Olympics five times in twenty years. The first known name of the city is Byzantium (Greek: Βυζάντιον, Byzántion), the name given to it at its foundation by Megarean colonists around 660 BCE. The name is thought to be derived from a personal name, Byzas. Ancient Greek tradition refers to a legendary king of that name as the leader of the Greek colonists. Modern scholars have also hypothesized that the name of Byzas was of local Thracian or Illyrian origin and hence predated the Megarean settlement. After Constantine the Great made it the new eastern capital of the Roman Empire in 330 CE, the city became widely known as "Constantinopolis" (Constantinople), which, as the Latinized form of "Κωνσταντινούπολις" (Konstantinoúpolis), means the "City of Constantine". He also attempted to promote the name "Nova Roma" and its Greek version "Νέα Ῥώμη" Nea Romē (New Rome), but this did not enter widespread usage. Constantinople remained the most common name for the city in the West until the establishment of the Turkish Republic, and Kostantiniyye (Ottoman Turkish: قسطنطينيه) and Be Makam-e Qonstantiniyyah al-Mahmiyyah (meaning "the Protected Location of Constantinople") and İstanbul were the names used alternatively by the Ottomans during their rule. The use of Constantinople to refer to the city during the Ottoman period (from the mid-15th century) is now considered politically incorrect, even if not historically inaccurate, by Turks. By the 19th century, the city had acquired other names used by either foreigners or Turks. Europeans used Constantinople to refer to the whole of the city, but used the name Stamboul—as the Turks also did—to describe the walled peninsula between the Golden Horn and the Sea of Marmara. Pera (from the Greek word for "across") was used to describe the area between the Golden Horn and the Bosphorus, but Turks also used the name Beyoğlu (today the official name for one of the city's constituent districts). Islambol (meaning either "City of Islam" or "Full of Islam") was sometimes colloquially used to refer to the city, and was even engraved on some Ottoman coins, but the belief that it was the precursor to the present name, İstanbul, is belied by the fact that the latter existed well before the former and even predates the Ottoman conquest of the city. The name İstanbul (Turkish pronunciation: [isˈtanbuɫ], colloquially [ɯsˈtambuɫ]) is commonly held to derive from the Medieval Greek phrase "εἰς τὴν Πόλιν" (pronounced [is tim ˈbolin]), which means "to the city" and is how Constantinople was referred to by the local Greeks. This reflected its status as the only major city in the vicinity. The importance of Constantinople in the Ottoman world was also reflected by its Ottoman name 'Der Saadet' meaning the 'gate to Prosperity' in Ottoman. An alternative view is that the name evolved directly from the name Constantinople, with the first and third syllables dropped. A Turkish folk etymology traces the name to Islam bol "plenty of Islam" because the city was called Islambol ("plenty of Islam") or Islambul ("find Islam") as the capital of the Islamic Ottoman Empire. It is first attested shortly after the conquest, and its invention was ascribed by some contemporary writers to Sultan Mehmed II himself. Some Ottoman sources of the 17th century, such as Evliya Çelebi, describe it as the common Turkish name of the time; between the late 17th and late 18th centuries, it was also in official use. The first use of the word "Islambol" on coinage was in 1703 (1115 AH) during the reign of Sultan Ahmed III. Nevertheless, the use of the name Constantinople remained common in English into the 20th century, Istanbul became common only after Turkey adapted the Latin alphabet in 1928 and urged other countries to use the city's Turkish name. In modern Turkish, the name is written as İstanbul, with a dotted İ, as the Turkish alphabet distinguishes between a dotted and dotless I. In English the stress is on the last syllable (bul), but in Turkish it is on the second syllable (tan). A person from the city is an İstanbullu (plural: İstanbullular), although Istanbulite is used in English. Neolithic artifacts, uncovered by archeologists at the beginning of the 21st century, indicate that Istanbul's historic peninsula was settled as far back as the 7th millennium BCE. That early settlement, important in the spread of the Neolithic Revolution from the Near East to Europe, lasted for almost a millennium before being inundated by rising water levels. The first human settlement on the Asian side, the Fikirtepe mound, is from the Copper Age period, with artifacts dating from 5500 to 3500 BCE, On the European side, near the point of the peninsula (Sarayburnu), there was a Thracian settlement during the early 1st millennium BCE. Modern authors have linked it to the Thracian toponym Lygos, mentioned by Pliny the Elder as an earlier name for the site of Byzantium. The history of the city proper begins around 660 BCE, when Greek settlers from Megara established Byzantium on the European side of the Bosphorus. The settlers built an acropolis adjacent to the Golden Horn on the site of the early Thracian settlements, fueling the nascent city's economy. The city experienced a brief period of Persian rule at the turn of the 5th century BCE, but the Greeks recaptured it during the Greco-Persian Wars. Byzantium then continued as part of the Athenian League and its successor, the Second Athenian Empire, before gaining independence in 355 BCE. Long allied with the Romans, Byzantium officially became a part of the Roman Empire in 73 CE. Byzantium's decision to side with the Roman usurper Pescennius Niger against Emperor Septimius Severus cost it dearly; by the time it surrendered at the end of 195 CE, two years of siege had left the city devastated. Five years later, Severus began to rebuild Byzantium, and the city regained—and, by some accounts, surpassed—its previous prosperity. Rise and fall of Constantinople and the Byzantine Empire Constantine the Great effectively became the emperor of the whole of the Roman Empire in September 324. Two months later, he laid out the plans for a new, Christian city to replace Byzantium. As the eastern capital of the empire, the city was named Nova Roma; most called it Constantinople, a name that persisted into the 20th century. On 11 May 330, Constantinople was proclaimed the capital of the Roman Empire, which was later permanently divided between the two sons of Theodosius I upon his death on 17 January 395, when the city became the capital of the Eastern Roman (Byzantine) Empire. The establishment of Constantinople served as one of Constantine's most lasting accomplishments, shifting Roman power eastward as the city became a center of Greek culture and Christianity. Numerous churches were built across the city, including the Hagia Sophia which was built during the reign of Justinian the Great and remained the world's largest cathedral for a thousand years. Constantine also undertook a major renovation and expansion of the Hippodrome of Constantinople; accommodating tens of thousands of spectators, the hippodrome became central to civic life and, in the 5th and 6th centuries, the epicenter of episodes of unrest, including the Nika riots. Constantinople's location also ensured its existence would stand the test of time; for many centuries, its walls and seafront protected Europe against invaders from the east and the advance of Islam. During most of the Middle Ages, the latter part of the Byzantine era, Constantinople was the largest and wealthiest city on the European continent and at times the largest in the world. Constantinople began to decline continuously after the end of the reign of Basil II in 1025. The final blow was given by the conquest of Villardouin and Enrico Dandolo in 1204 during the Fourth Crusade, where the City was sacked and pillaged. The city subsequently became the center of the Latin Empire, created by Catholic crusaders to replace the Orthodox Byzantine Empire. Hagia Sophia was converted to a catholic church in 1204. The Byzantine Empire was restored, albeit weakened, in 1261. Constantinople's churches, defenses, and basic services were in disrepair, and its population had dwindled to a hundred thousand from half a million during the 8th century. After the reconquest of 1261, however some of the City's monuments were restored, like the 2 Deisis mosaics in Aghia Sofia and Kariye were created. Various economic and military policies instituted by Andronikos II, such as the reduction of military forces, weakened the empire and left it vulnerable to attack. In the mid-14th-century, the Ottoman Turks began a strategy of gradually taking smaller towns and cities, cutting off Constantinople's supply routes and strangling it slowly. On 29 May 1453, after an eight-week siege (during which the last Roman emperor, Constantine XI, was killed), Sultan Mehmed II "the Conqueror" captured Constantinople and declared it the new capital of the Ottoman Empire. Hours later, the sultan rode to the Hagia Sophia and summoned an imam to proclaim the Islamic creed, converting the grand cathedral into an imperial mosque due to the city's refusal to surrender peacefully. Mehmed declared himself as the new "Kaysar-i Rûm" (the Ottoman Turkish equivalent of Caesar of Rome) and the Ottoman state was reorganized into an empire. Ottoman Empire and Turkish Republic eras Following the conquest of Constantinople, Mehmed II immediately set out to revitalize the city, by then also known as Istanbul. He urged the return of those who had fled the city during the siege, and resettled Muslims, Jews, and Christians from other parts of Anatolia. He demanded that five thousand households needed to be transferred to Constantinople by September. From all over the Islamic empire, prisoners of war and deported people were sent to the city: these people were called "Sürgün" in Turkish (Greek: σουργουνιδες). However, many people escaped again from the city, and there were several outbreaks of plague, so that in 1459 Mehmet allowed the deported Greeks to come back to the city. He also invited people from all over Europe to his capital, creating a cosmopolitan society that persisted through much of the Ottoman period. Plague continued, however, to be essentially endemic in Istanbul for the rest of the century, as it had been from 1520, with a few years of respite between 1529 and 1533, 1549 and 1552, and from 1567 to 1570; epidemics originating in the West and in the Hejaz and southern Russia. Population growth in Anatolia, however, allowed Istanbul to replace its losses and maintain its population of around 500,000 inhabitants down to 1800. Mehmed II also repaired the city's damaged infrastructure, including the whole water system, began to build the Grand Bazaar, and constructed Topkapı Palace, the sultan's official residence. With the transfer of the capital from Edirne (formerly Adrianople) to Constantinople, the new state was declared as the successor and continuation of the Roman Empire. The Ottomans quickly transformed the city from a bastion of Christianity to a symbol of Islamic culture. Religious foundations were established to fund the construction of ornate imperial mosques, often adjoined by schools, hospitals, and public baths. The Ottoman Dynasty claimed the status of caliphate in 1517, with Istanbul remaining the capital of this last caliphate for four centuries. Suleiman the Magnificent's reign from 1520 to 1566 was a period of especially great artistic and architectural achievement; chief architect Mimar Sinan designed several iconic buildings in the city, while Ottoman arts of ceramics, stained glass, calligraphy, and miniature flourished. The population of Istanbul was 570,000 by the end of the 18th century. A period of rebellion at the start of the 19th century led to the rise of the progressive Sultan Mahmud II and eventually to the Tanzimat period, which produced political reforms and allowed new technology to be introduced to the city. Bridges across the Golden Horn were constructed during this period, and Istanbul was connected to the rest of the European railway network in the 1880s. Modern facilities, such as a water supply network, electricity, telephones, and trams, were gradually introduced to Istanbul over the following decades, although later than to other European cities. The modernization efforts were not enough to forestall the decline of the Ottoman Empire. In the early 20th century, the Young Turk Revolution deposed Sultan Abdul Hamid II and a series of wars plagued the ailing empire's capital. The last of these, World War I, resulted in the British, French, and Italian occupation of Constantinople. The Armenian population of the city was also affected by the deportation of Armenian intellectuals on 24 April 1915, in which leaders of the Armenian community were arrested and mostly killed as part of the Armenian Genocide. To commemorate the victims of the Armenian Genocide, 24 April has now become the day of remembrance. The final Ottoman sultan, Mehmed VI, was exiled in November 1922; the following year, the occupation of Constantinople ended with the signing of the Treaty of Lausanne and the recognition of the Republic of Turkey, declared by Mustafa Kemal Atatürk. In the early years of the republic, Istanbul was overlooked in favor of Ankara, selected as Turkey's capital to distance the new, secular country from its Ottoman history. From the late 1940s and early 1950s, Istanbul underwent great structural change, as new public squares, boulevards, and avenues were constructed throughout the city, sometimes at the expense of historical buildings. The population of Istanbul began to rapidly increase in the 1970s, as people from Anatolia migrated to the city to find employment in the many new factories that were built on the outskirts of the sprawling metropolis. This sudden, sharp rise in the city's population caused a large demand for housing, and many previously outlying villages and forests became engulfed into the metropolitan area of Istanbul. Istanbul is located in north-western Turkey within the Marmara Region on a total area of 5,343 square kilometers (2,063 sq mi). The Bosphorus, which connects the Sea of Marmara to the Black Sea, divides the city into a European, Thracian side—comprising the historic and economic centers—and an Asian, Anatolian side. The city is further divided by the Golden Horn, a natural harbor bounding the peninsula where the former Byzantium and Constantinople were founded. The confluence of the Sea of Marmara, the Bosphorus, and the Golden Horn at the heart of present-day Istanbul has deterred attacking forces for thousands of years and remains a prominent feature of the city's landscape. Following the model of Rome, the historic peninsula is said to be characterized by seven hills, each topped by imperial mosques. The easternmost of these hills is the site of Topkapı Palace on the Sarayburnu. Rising from the opposite side of the Golden Horn is another, conical hill, where the modern Beyoğlu district is situated. Because of the topography, buildings in Beyoğlu were once constructed with the help of terraced retaining walls, and roads were laid out in the form of steps. Üsküdar on the Asian side exhibits similarly hilly characteristics, with the terrain gradually extending down to the Bosphorus coast, but the landscape in Şemsipaşa and Ayazma is more abrupt, akin to a promontory. The highest point in Istanbul is Çamlıca Hill, with an altitude of 288 meters (945 ft). The northern half of Istanbul has a higher mean elevation compared to the south coast, with locations surpassing 200 meters (660 ft), and some coasts with steep cliffs resembling fjords, especially around the northern end of the Bosporus, where it opens up to the Black Sea. Istanbul is situated near the North Anatolian Fault, close to the boundary between the African and Eurasian Plates. This fault zone, which runs from northern Anatolia to the Sea of Marmara, has been responsible for several deadly earthquakes throughout the city's history. Among the most devastating of these seismic events was the 1509 earthquake, which caused a tsunami that broke over the walls of the city and killed more than 10,000 people. More recently, in 1999, an earthquake with its epicenter in nearby İzmit left 18,000 people dead, including 1,000 people in Istanbul's suburbs. The people of Istanbul remain concerned that an even more catastrophic seismic event may be in the city's near future, as thousands of structures recently built to accommodate Istanbul's rapidly increasing population may not have been constructed properly. Seismologists say the risk of a 7.6-magnitude or greater earthquake striking Istanbul by 2030 is more than 60 percent. In the Köppen–Geiger classification system, Istanbul has a borderline Mediterranean climate (Csa), humid subtropical climate (Cfa) and oceanic climate (Cfb), due to its location in a transitional climatic zone. Since precipitation in summer months, ranges from 20 to 65 mm (1 to 3 in), depending on location, the city cannot be classified as solely Mediterranean or humid subtropical. Due to its size, diverse topography, maritime location and most importantly having a coastline to two different bodies of water to the north and south, Istanbul exhibits microclimates. The northern half of the city, as well as the Bosporus coastline, express characteristics of oceanic and humid subtropical climates, because of humidity from the Black Sea and the relatively high concentration of vegetation. The climate in the populated areas of the city to the south, located on the Sea of Marmara, is warmer, drier and less affected by humidity. The annual precipitation in the northern half can be twice as much (Bahçeköy, 1166.6 mm), than it is in the southern, Marmara coast (Florya 635.0 mm). There is a significant difference between annual mean temperatures on the north and south coasts as well, Bahçeköy 12.8 °C (55.0 °F), Kartal 15.03 °C (59.05 °F). Parts of the province, that are away from both seas exhibit considerable continental influences, with much more pronounced night-day and summer-winter temperature differences. In winter some parts of the province average freezing or below at night. Istanbul's persistently high humidity reaches 80 percent most mornings. Because of this, fog is very common, although more so in northern parts of the city and away from the city center. Dense fog disrupts transportation in the region, including on the Bosphorus, and is common during the autumn and winter months when the humidity remains high into the afternoon. The humid conditions and the fog tend to dissipate by midday during the summer months, but the lingering humidity exacerbates the moderately high summer temperatures. During these summer months, high temperatures average around 29 °C (84 °F) and rainfall is uncommon; there are only about fifteen days with measurable precipitation between June and August. The summer months also have the highest concentration of thunderstorms. Winter is colder in Istanbul than in most other cities around the Mediterranean Basin, with low temperatures averaging 1–4 °C (34–39 °F). Lake-effect snow from the Black Sea is common, although difficult to forecast, with the potential to be heavy and—as with the fog—disruptive to the city's infrastructure. Spring and autumn are mild, but often wet and unpredictable; chilly winds from the northwest and warm gusts from the south—sometimes in the same day—tend to cause fluctuations in temperature. Overall, Istanbul has an annual average of 130 days with significant precipitation, which amounts to 810 millimeters (31.9 in) per year. The highest and lowest temperatures ever recorded in the city center on the Marmara coast are 40.5 °C (105 °F) and −16.1 °C (3 °F). The greatest rainfall recorded in a day is 227 millimeters (8.9 in), and the highest recorded snow cover is 80 centimeters (31 in). |Climate data for Istanbul (Sarıyer), 1950–2015| |Record high °C (°F)|| 22.0 |Average high °C (°F)|| 8.5 |Daily mean °C (°F)|| 5.7 |Average low °C (°F)|| 3.2 |Record low °C (°F)|| −11.0 |Average precipitation mm (inches)|| 105.0 |Average precipitation days (≥ 0.1 mm)||17.5||15.3||13.8||10.4||8.1||6.1||4.2||4.9||7.4||11.3||13.2||17.2||129.4| |Mean monthly sunshine hours||71.3||87.6||133.3||180.0||251.1||300.0||322.4||294.5||243.0||164.3||102.0||68.2||2,217.7| |Source: Turkish State Meteorological Service (sun, 1960–2012)| |Climate data for Istanbul (Kireçburnu, Sarıyer), 1949–1999| |Average high °C (°F)|| 8.3 |Daily mean °C (°F)|| 5.5 |Average low °C (°F)|| 3.0 |Average precipitation mm (inches)|| 103.6 |Average snowy days (≥ 0.1 mm)||3.6||4.9||2.8||0.0||0.0||0.0||0.0||0.0||0.0||0.0||0.3||1.5||13.1| |Source: Turkish State Meteorological Service (1949–1999)| |Climate data for Istanbul (Bahçeköy, Sarıyer), 1949–1999| |Average high °C (°F)|| 8.0 |Daily mean °C (°F)|| 4.6 |Average low °C (°F)|| 1.7 |Average precipitation mm (inches)|| 152.1 |Average snowy days (≥ 0.1 mm)||4.6||5.2||3.9||0.1||0.0||0.0||0.0||0.0||0.0||0.0||0.5||3.0||17.3| |Source: Turkish State Meteorological Service (1949–1999)| |Historic Areas of Istanbul| |Name as inscribed on the World Heritage List| |Criteria||I, II, III, IV| |UNESCO region||Europe and North America| |Inscription||1985 (9th Session)| The Fatih district, which was named after Sultan Mehmed the Conqueror (Turkish: Fatih Sultan Mehmed), corresponds to what was, until the Ottoman conquest in 1453, the whole of the city of Constantinople (today called the historic peninsula of Istanbul) on the southern shore of the Golden Horn, across the medieval Genoese citadel of Galata on the northern shore. The Genoese fortifications in Galata were largely demolished in the 19th century, leaving only the Galata Tower, to make way for the northward expansion of the city. Galata (Karaköy) is today a quarter within the Beyoğlu (Pera) district, which forms Istanbul's commercial and entertainment center and includes İstiklal Avenue and Taksim Square. Dolmabahçe Palace, the seat of government during the late Ottoman period, is located in the Beşiktaş district on the European shore of the Bosphorus strait, to the north of Beyoğlu. The Sublime Porte (Bâb-ı Âli), which became a metonym for the Ottoman government, was originally used to describe the Imperial Gate (Bâb-ı Hümâyûn) at the outermost courtyard of the Topkapı Palace; but after the 18th century, the Sublime Porte (or simply Porte) began to refer to the gate of the Sadrazamlık (Prime Ministry) compound in the Cağaloğlu quarter near Topkapı Palace, where the offices of the Sadrazam (Grand Vizier) and other Viziers were located, and where foreign diplomats were received. The former village of Ortaköy is situated within Beşiktaş and gives its name to the Ortaköy Mosque on the Bosphorus, near the Bosphorus Bridge. Lining both the European and Asian shores of the Bosphorus are the historic yalıs, luxurious chalet mansions built by Ottoman aristocrats and elites as summer homes. Farther inland, outside the city's inner ring road, are Levent and Maslak, Istanbul's main business districts. During the Ottoman period, Üsküdar and Kadıköy were outside the scope of urban Istanbul, serving as tranquil outposts with seaside yalıs and gardens. But in the second half of the 20th century, the Asian side experienced major urban growth; the late development of this part of the city led to better infrastructure and tidier urban planning when compared with most other residential areas in the city. Much of the Asian side of the Bosphorus functions as a suburb of the economic and commercial centers in European Istanbul, accounting for a third of the city's population but only a quarter of its employment. As a result of Istanbul's exponential growth in the 20th century, a significant portion of the city is composed of gecekondus (literally "built overnight"), referring to illegally constructed squatter buildings. At present, some gecekondu areas are being gradually demolished and replaced by modern mass-housing compounds. Moreover, large scale gentrification and urban renewal projects have been taking place, such as the one in Tarlabaşı; some of these projects, like the one in Sulukule, have faced criticism. The Turkish government also has ambitious plans for an expansion of the city west and northwards on the European side in conjunction with plans for a third airport; the new parts of the city will include four different settlements with specified urban functions, housing 1.5 million people. Istanbul does not have a primary urban park, but it has several green areas. Gülhane Park and Yıldız Park were originally included within the grounds of two of Istanbul's palaces—Topkapı Palace and Yıldız Palace—but they were repurposed as public parks in the early decades of the Turkish Republic. Another park, Fethi Paşa Korusu, is situated on a hillside adjacent to the Bosphorus Bridge in Anatolia, opposite Yıldız Palace in Europe. Along the European side, and close to the Fatih Sultan Mehmet Bridge, is Emirgan Park, which was known as the Kyparades (Cypress Forest) during the Byzantine period. In the Ottoman period, it was first granted to Nişancı Feridun Ahmed Pasha in the 16th century, before being granted by Sultan Murad IV to the Safavid Emir Gûne Han in the 17th century, hence the name Emirgan. The 47-hectare (120-acre) park was later owned by Khedive Ismail Pasha of Ottoman Egypt and Sudan in the 19th century. Emirgan Park is known for its diversity of plants and an annual tulip festival is held there since 2005. The AKP government's decision to replace Taksim Gezi Park with a replica of the Ottoman era Taksim Military Barracks (which was transformed into the Taksim Stadium in 1921, before being demolished in 1940 for building Gezi Park) sparked a series of nationwide protests in 2013 covering a wide range of issues. Popular during the summer among Istanbulites is Belgrad Forest, spreading across 5,500 hectares (14,000 acres) at the northern edge of the city. The forest originally supplied water to the city and remnants of reservoirs used during Byzantine and Ottoman times survive. Istanbul is primarily known for its Byzantine and Ottoman architecture, but its buildings reflect the various peoples and empires that have previously ruled the city. Examples of Genoese and Roman architecture remain visible in Istanbul alongside their Ottoman counterparts. Nothing of the architecture of the classical Greek period has survived, but Roman architecture has proved to be more durable. The obelisk erected by Theodosius in the Hippodrome of Constantinople is still visible in Sultanahmet Square, and a section of the Valens Aqueduct, constructed in the late 4th century, stands relatively intact at the western edge of the Fatih district. The Column of Constantine, erected in 330 CE to mark the new Roman capital, stands not far from the Hippodrome. Early Byzantine architecture followed the classical Roman model of domes and arches, but improved upon these elements, as in the Church of the Saints Sergius and Bacchus. The oldest surviving Byzantine church in Istanbul—albeit in ruins—is the Monastery of Stoudios (later converted into the Imrahor Mosque), which was built in 454. After the recapture of Constantinople in 1261, the Byzantines enlarged two of the most important churches extant, Chora Church and Pammakaristos Church. The pinnacle of Byzantine architecture, and one of Istanbul's most iconic structures, is the Hagia Sophia. Topped by a dome 31 meters (102 ft) in diameter, the Hagia Sophia stood as the world's largest cathedral for centuries, and was later converted into a mosque and, as it stands now, a museum. Among the oldest surviving examples of Ottoman architecture in Istanbul are the Anadoluhisarı and Rumelihisarı fortresses, which assisted the Ottomans during their siege of the city. Over the next four centuries, the Ottomans made an indelible impression on the skyline of Istanbul, building towering mosques and ornate palaces. The largest palace, Topkapı, includes a diverse array of architectural styles, from Baroque inside the Harem, to its Neoclassical style Enderûn Library. The imperial mosques include Fatih Mosque, Bayezid Mosque, Yavuz Selim Mosque, Süleymaniye Mosque, Sultan Ahmed Mosque (the Blue Mosque), and Yeni Mosque, all of which were built at the peak of the Ottoman Empire, in the 16th and 17th centuries. In the following centuries, and especially after the Tanzimat reforms, Ottoman architecture was supplanted by European styles. An example of which is the imperial Nuruosmaniye Mosque. Areas around İstiklal Avenue were filled with grand European embassies and rows of buildings in Neoclassical, Renaissance Revival and Art Nouveau styles, which went on to influence the architecture of a variety of structures in Beyoğlu—including churches, stores, and theaters—and official buildings such as Dolmabahçe Palace. Since 2004, the municipal boundaries of Istanbul have been coincident with the boundaries of its province. The city, considered capital of Istanbul Province, is administered by the Istanbul Metropolitan Municipality (MMI), which oversees the 39 districts of the city-province. The current city structure can be traced back to the Tanzimat period of reform in the 19th century, before which Islamic judges and imams led the city under the auspices of the Grand Vizier. Following the model of French cities, this religious system was replaced by a mayor and a citywide council composed of representatives of the confessional groups (millet) across Istanbul. Beyoğlu was the first area of the city to have its own director and council, with members instead being longtime residents of the neighborhood. Laws enacted after the Ottoman constitution of 1876 aimed to expand this structure across the city, imitating the twenty arrondissements of Paris, but they were not fully implemented until 1908, when Istanbul was declared a province with nine constituent districts. This system continued beyond the founding of the Turkish Republic, with the province renamed a belediye (municipality), but the municipality was disbanded in 1957. Small settlements adjacent to major population centers in Turkey, including Istanbul, were merged into their respective primary cities during the early 1980s, resulting in metropolitan municipalities. The main decision-making body of the Istanbul Metropolitan Municipality is the Municipal Council, with members drawn from district councils. The Municipal Council is responsible for citywide issues, including managing the budget, maintaining civic infrastructure, and overseeing museums and major cultural centers. Since the government operates under a "powerful mayor, weak council" approach, the council's leader—the metropolitan mayor—has the authority to make swift decisions, often at the expense of transparency. The Municipal Council is advised by the Metropolitan Executive Committee, although the Committee also has limited power to make decisions of its own. All representatives on the Committee are appointed by the metropolitan mayor and the Council, with the mayor—or someone of his or her choosing—serving as head. District councils are chiefly responsible for waste management and construction projects within their respective districts. They each maintain their own budgets, although the metropolitan mayor reserves the right to review district decisions. One-fifth of all district council members, including the district mayors, also represent their districts in the Municipal Council. All members of the district councils and the Municipal Council, including the metropolitan mayor, are elected to five-year terms. Representing the Justice and Development Party, Kadir Topbaş has been Mayor of Istanbul since March 2004. With the Istanbul Metropolitan Municipality and Istanbul Province having equivalent jurisdictions, few responsibilities remain for the provincial government. Similar to the MMI, the Istanbul Special Provincial Administration has a governor, a democratically elected decision-making body—the Provincial Parliament—and an appointed Executive Committee. Mirroring the executive committee at the municipal level, the Provincial Executive Committee includes a secretary-general and leaders of departments that advise the Provincial Parliament. The Provincial Administration's duties are largely limited to the building and maintenance of schools, residences, government buildings, and roads, and the promotion of arts, culture, and nature conservation. Hüseyin Avni Mutlu has been Governor of Istanbul Province since May 2010. | Sources: Jan Lahmeyer 2004,Chandler 1987, Morris 2010,Turan 2010 | Pre-Republic figures estimated Throughout most of its history, Istanbul has ranked among the largest cities in the world. By 500 CE, Constantinople had somewhere between 400,000 and 500,000 people, edging out its predecessor, Rome, for world's largest city. Constantinople jostled with other major historical cities, such as Baghdad, Chang'an, Kaifeng and Merv for the position of world's most populous city until the 12th century. It never returned to being the world's largest, but remained Europe's largest city from 1500 to 1750, when it was surpassed by London. The Turkish Statistical Institute estimates that the population of Istanbul Metropolitan Municipality was 14,377,019 at the end of 2014, hosting 19 percent of the country's population. Other estimate that at the same time the population within city limits was 14,657,434. Then about 97–98% of the inhabitants of the metropolitan municipality were within city limits, up from 89% in 2007 and 61% in 1980. 64.7% of the residents live on the European side and 35.3% on the Asian side. While the city ranks as world's 7th-largest city proper, it drops the rank to the 24th place as an urban area and to the 18th place as a metro area because the city limits are roughly equivalent to the agglomeration. Today, it forms one of the largest urban agglomerations in Europe, alongside Moscow. The city's annual population growth of 3.45 percent ranks as the highest among the seventy-eight largest metropolises in the Organisation for Economic Co-operation and Development. The high population growth mirrors an urbanization trend across the country, as the second and third fastest-growing OECD metropolises are the Turkish cities of İzmir and Ankara. Istanbul experienced especially rapid growth during the second half of the 20th century, with its population increasing tenfold between 1950 and 2000. This growth in population comes, in part, from an expansion of city limits—particularly between 1980 and 1985, when the number of Istanbulites nearly doubled. The remarkable growth was, and still is, largely fueled by migrants from eastern Turkey seeking employment and improved living conditions. The number of residents of Istanbul originating from seven northern and eastern provinces is greater than the populations of their entire respective provinces; Sivas and Kastamonu each account for more than half a million residents of Istanbul. Istanbul's foreign population, by comparison, is very small, 42,228 residents in 2007. Only 28 percent of the city's residents are originally from Istanbul. The most densely populated areas tend to lie to the northwest, west, and southwest of the city center, on the European side; the most densely populated district on the Asian side is Üsküdar. Religious and ethnic groups Istanbul has been a cosmopolitan city throughout much of its history, but it has become more homogenized since the end of the Ottoman Empire. Most of Turkey's religious and ethnic minorities remain concentrated in Istanbul. The vast majority of people across Turkey, and in Istanbul, are Muslim, and more specifically members of the Sunni branch of Islam. Most Sunnis follow the Hanafi school of Islamic thought, although approximately 10 percent of Sunnis follow the Shafi'i school. The largest non-Sunni Muslim sect, accounting for 4.5 million Turks, is the Alevis; a third of all Alevis in the country live in Istanbul. Mystic movements, like Sufism, were officially banned after the establishment of the Turkish Republic, but they still boast numerous followers. The Patriarch of Constantinople has been designated Ecumenical Patriarch since the sixth century, and has subsequently come to be widely regarded as the leader of the world's 300 million Orthodox Christians. Since 1601, the Patriarchate has been based in Istanbul's Church of St. George. Into the 19th century, the Christians of Istanbul tended to be either Greek Orthodox or members of the Armenian Apostolic Church. The headquarters of the Turkish Orthodox Church are located in the city. Because of events during the 20th century—including the 1923 population exchange between Greece and Turkey, a 1942 wealth tax, and the 1955 Istanbul riots—the Greek population, originally centered in Fener and Samatya, has decreased substantially. At the start of the 21st century, Istanbul's Greek population numbered 3,000 (down from 130,000 in 1923 and 260,000 according to the Ottoman Census of 1910 of 850,000 total). There are today between 50,000 and 70,000 Armenians in Istanbul, down from 164,000 in 1913 partly due to the Armenian Genocide. Christians made up half the population of the city in 1910. The largest ethnic minority in Istanbul is the Kurdish community, originating from eastern and southeastern Turkey. Although the Kurdish presence in the city dates back to the early Ottoman period, the influx of Kurds into the city has accelerated since the beginning of the Kurdish–Turkish conflict with the Kurdistan Workers' Party (i.e. since the late 1970s). About two to three million residents of Istanbul are Kurdish, meaning there are more Kurds in Istanbul than in any other city in the world. There are other significant ethnic minorities as well, the Bosniaks are the main people of an entire district – Bayrampaşa. The neighborhood of Balat used to be home to a sizable Sephardi Jewish community, first formed during the period of the Spanish Inquisition. Romaniotes and Ashkenazi Jews resided in Istanbul even before the Sephardim, but their proportion has since dwindled; today, 1 percent of Istanbul's Jews are Ashkenazi. In large part due to emigration to Israel, the Jewish population nationwide dropped from 100,000 in 1950 to 18,000 in 2005, with the majority of them living in either Istanbul or İzmir. Levantines, Latin Christians who settled in Galata during the Ottoman period, played a seminal role in shaping the culture and architecture of Istanbul during the 19th and early 20th centuries; their population has dwindled, but they remain in the city in small numbers. From the increase in mutual cooperation between Turkey and several African States like Somalia and Djibouti, several young students and workers have been migrating to Istanbul in search of better education and employment opportunities. There is also a small Nigerian, Congolese and Cameroonian and North African community present. 25 / 39 14 / 39 46 / 88 28 / 88 7 / 88 7 / 88 Istanbul has voted for the winning party in general elections since 1995. Since 2002, the right-wing Justice and Development Party (AKP) has won pluralities in every general and local election. The city's electorate has also voted for the AKP government's constitutional reforms proposed during the 2007 and 2010 constitutional referenda. Turkish President and former AKP Prime Minister Recep Tayyip Erdoğan was elected Mayor of İstanbul in the 1994 local elections as the Islamist Welfare Party candidate with 25.1% of the vote, winning due to a vote split between the mainstream centrist parties. Conservative parties traditionally find support in older districts with high population densities such as Bağcılar, Fatih, Sultanbeyli and Esenler. The opposition Kemalist center-left Republican People's Party (CHP), currently the second major political force in both İstanbul and the country, gets most of its support from more rural districts such as Silivri, Çatalca and Sarıyer. Urban districts such as Beşiktaş, Bakırköy, Şişli and Kadıköy have returned strong support for the CHP in past elections. The CHP are generally strongest in the west, where newer residential developments are taking place. İstanbul has 39 districts, more than any other province in Turkey. Since İstanbul is Turkey's largest city and has usually voted in the same way as the country as a whole, it is largely perceived in Turkish politics that the winning party of an election is essentially decided by İstanbul's electorate. Political parties thus allocate substantial amounts of electoral campaign funds and to winning control of the İstanbul Metropolitan Municipality. Due to its electoral importance, İstanbul has reported the largest and most serious cases of electoral fraud in recent elections, including the 2014 local elections. The incumbent mayor of the city is Kadir Topbaş of the AKP, who was first elected in the 2004 local elections and succeeded Ali Müfit Gürtuna of the closed down Welfare Party. He was re-elected in 2009 and 2014. The leader of the CHP and parliamentary opposition, Kemal Kılıçdaroğlu, ran against Topbaş in the 2009 local elections. He is currently a Member of Parliament for İstanbul. Between 2007 and 2014, Prime Minister Recep Tayyip Erdoğan was also an MP for İstanbul. For general elections, the city is divided into 3 electoral districts and returns 85 MPs to the Turkish parliament. In the 2014 presidential election, 49.83% of the city's electorate voted for AKP candidate Recep Tayyip Erdoğan. Although Erdoğan won the most votes in İstanbul, his failure to win above 50% was seen as significant. Opposition candidate Ekmeleddin İhsanoğlu came second with 41.08% and the HDP pro-Kurdish and left-wing candidate Selahattin Demirtaş won a substantial 9.09%. In 2013 and 2014, large-scale anti-AKP government protests began in İstanbul and spread throughout the nation. With a PPP-adjusted gross domestic product of US$301.1 billion, Istanbul ranked 29th among the world's urban areas in 2011. Since the mid-1990s, Istanbul's economy has been one of the fastest-growing among OECD metro-regions. Istanbul is responsible for 27 percent of Turkey's GDP, with 20 percent of the country's industrial labor force residing in the city. Its GDP per capita and productivity are greater than their national averages by 70 percent and 50 percent, respectively, owing in part to the focus on high-value-added activities. With its high population and significant contribution to the Turkish economy, Istanbul is responsible for two-fifths of the nation's tax revenue. That includes the taxes of 37 US-dollar billionaires based in Istanbul, the fifth-highest number among cities around the world. As expected for a city of its size, Istanbul has a diverse industrial economy, producing commodities as varied as olive oil, tobacco, vehicles, and electronics. Despite having a focus on high-value-added work, its low-value-added manufacturing sector is substantial, representing just 26 percent of Istanbul's GDP, but four-fifths of the city's total exports. In 2005, companies based in Istanbul produced exports worth $41.4 billion and received imports totaling $69.9 billion; these figures were equivalent to 57 percent and 60 percent, respectively, of the national totals. Istanbul is home to Borsa Istanbul, the sole exchange entity of Turkey, which combined the former Istanbul Stock Exchange, the Istanbul Gold Exchange, and the Derivatives Exchange of Turkey. The former Istanbul Stock Exchange was originally established as the Ottoman Stock Exchange in 1866. During the 19th and early 20th centuries, Bankalar Caddesi (Banks Street) in Galata was the financial center of the Ottoman Empire, where the Ottoman Stock Exchange was located. Bankalar Caddesi continued to be Istanbul's main financial district until the 1990s, when most Turkish banks began moving their headquarters to the modern central business districts of Levent and Maslak. In 1995, the Istanbul Stock Exchange (now Borsa Istanbul) moved to its current building in the İstinye quarter of the Sarıyer district. A new central business district is also under construction in Ataşehir and will host the headquarters of various Turkish banks and financial institutions upon completion. As the only sea route between the oil-rich Black Sea and the Mediterranean, the Bosphorus is one of the busiest waterways in the world; more than 200 million tonnes of oil pass through the strait each year, and the traffic on the Bosphorus is three times that on the Suez Canal. As a result, there have been proposals to build a canal, known as Canal Istanbul, parallel to the strait, on the European side of the city. Istanbul has three major shipping ports—the Port of Haydarpaşa, the Port of Ambarlı, and the Port of Zeytinburnu—as well as several smaller ports and oil terminals along the Bosphorus and the Sea of Marmara. Haydarpaşa, situated at the southeastern end of the Bosphorus, was Istanbul's largest port until the early 2000s. Shifts in operations to Ambarlı since then have left Haydarpaşa running under capacity and with plans to decommission the port. In 2007, Ambarlı, on the western edge of the urban center, had an annual capacity of 1.5 million TEUs (compared to 354,000 TEUs at Haydarpaşa), making it the fourth-largest cargo terminal in the Mediterranean basin. The Port of Zeytinburnu is advantaged by its proximity to motorways and Atatürk International Airport, and long-term plans for the city call for greater connectivity between all terminals and the road and rail networks. Istanbul is an increasingly popular tourist destination; whereas just 2.4 million foreigners visited the city in 2000, it welcomed 12.56 million foreign tourists in 2015, making it the world's fifth most-visited city. Istanbul is Turkey's second-largest international gateway, after Antalya, receiving a quarter of the nation's foreign tourists. Istanbul's tourist industry is concentrated in the European side, with 90 percent of the city's hotels located there. Low- and mid-range hotels tend to be located on the Sarayburnu; higher-end hotels are primarily located in the entertainment and financial centers north of the Golden Horn. Istanbul's seventy museums, the most visited of which are the Topkapı Palace Museum and the Hagia Sophia, bring in $30 million in revenue each year. The city's environmental master plan also notes that there are 17 palaces, 64 mosques, and 49 churches of historical significance in Istanbul. Istanbul was historically known as a cultural hub, but its cultural scene stagnated after the Turkish Republic shifted its focus toward Ankara. The new national government established programs that served to orient Turks toward musical traditions, especially those originating in Europe, but musical institutions and visits by foreign classical artists were primarily centered in the new capital. Much of Turkey's cultural scene had its roots in Istanbul, and by the 1980s and 1990s Istanbul reemerged globally as a city whose cultural significance is not solely based on its past glory. By the end of the 19th century, Istanbul had established itself as a regional artistic center, with Turkish, European, and Middle Eastern artists flocking to the city. Despite efforts to make Ankara Turkey's cultural heart, Istanbul had the country's primary institution of art until the 1970s. When additional universities and art journals were founded in Istanbul during the 1980s, artists formerly based in Ankara moved in. Beyoğlu has been transformed into the artistic center of the city, with young artists and older Turkish artists formerly residing abroad finding footing there. Modern art museums, including İstanbul Modern, the Pera Museum, Sakıp Sabancı Museum and SantralIstanbul, opened in the 2000s to complement the exhibition spaces and auction houses that have already contributed to the cosmopolitan nature of the city. These museums have yet to attain the popularity of older museums on the historic peninsula, including the Istanbul Archaeology Museums, which ushered in the era of modern museums in Turkey, and the Turkish and Islamic Arts Museum. The first film screening in Turkey was at Yıldız Palace in 1896, a year after the technology publicly debuted in Paris. Movie theaters rapidly cropped up in Beyoğlu, with the greatest concentration of theaters being along the street now known as İstiklal Avenue. Istanbul also became the heart of Turkey's nascent film industry, although Turkish films were not consistently developed until the 1950s. Since then, Istanbul has been the most popular location to film Turkish dramas and comedies. The Turkish film industry ramped up in the second half of the century, and with Uzak (2002) and My Father and My Son (2005), both filmed in Istanbul, the nation's movies began to see substantial international success. Istanbul and its picturesque skyline have also served as a backdrop for several foreign films, including Topkapi (1964), The World Is Not Enough (1999), and Mission Istaanbul (2008). Coinciding with this cultural reemergence was the establishment of the Istanbul Festival, which began showcasing a variety of art from Turkey and around the world in 1973. From this flagship festival came the International Istanbul Film Festival and the Istanbul International Jazz Festival in the early 1980s. With its focus now solely on music and dance, the Istanbul Festival has been known as the Istanbul International Music Festival since 1994. The most prominent of the festivals that evolved from the original Istanbul Festival is the Istanbul Biennial, held every two years since 1987. Its early incarnations were aimed at showcasing Turkish visual art, and it has since opened to international artists and risen in prestige to join the elite biennales, alongside the Venice Biennale and the São Paulo Art Biennial. Leisure and entertainment Istanbul has numerous shopping centers, from the historic to the modern. The Grand Bazaar, in operation since 1461, is among the world's oldest and largest covered markets. Mahmutpasha Bazaar is an open-air market extending between the Grand Bazaar and the Egyptian Bazaar, which has been Istanbul's major spice market since 1660. Galleria Ataköy ushered in the age of modern shopping malls in Turkey when it opened in 1987. Since then, malls have become major shopping centers outside the historic peninsula. Akmerkez was awarded the titles of "Europe's best" and "World's best" shopping mall by the International Council of Shopping Centers in 1995 and 1996; Istanbul Cevahir has been one of the continent's largest since opening in 2005; Kanyon won the Cityscape Architectural Review Award in the Commercial Built category in 2006. İstinye Park in İstinye and Zorlu Center near Levent are among the newest malls which include the stores of the world's top fashion brands. Abdi İpekçi Street in Nişantaşı and Bağdat Avenue on the Anatolian side of the city have evolved into high-end shopping districts. Istanbul is famous for its historic seafood restaurants. Many of the city's most popular and upscale seafood restaurants line the shores of the Bosphorus (particularly in neighborhoods like Ortaköy, Bebek, Arnavutköy, Yeniköy, Beylerbeyi and Çengelköy). Kumkapı along the Sea of Marmara has a pedestrian zone that hosts around fifty fish restaurants. The Prince Islands, 15 kilometers (9 mi) from the city center, are also popular for their seafood restaurants. Because of their restaurants, historic summer mansions, and tranquil, car-free streets, the Prince Islands are a popular vacation destination among Istanbulites and foreign tourists. Istanbul is also famous for its sophisticated and elaborately-cooked dishes of the Ottoman cuisine. However, following the influx of immigrants from southeastern and eastern Turkey, which began in the 1960s, the foodscape of the city has drastically changed by the end of the century; with influences of Middle Eastern cuisine such as kebab taking an important place in the food scene. Restaurants featuring foreign cuisines are mainly concentrated in the Beyoğlu, Beşiktaş, Şişli and Kadıköy districts. Istanbul is famous for its nightlife, as well as its historic taverns, a signature characteristic of the city for centuries if not millennia. Along the İstiklal Avenue is the Çiçek Pasajı, now home to winehouses (known as meyhanes), pubs, and restaurants. İstiklal Avenue, originally famous for its taverns, has shifted toward shopping, but the nearby Nevizade Street is still lined with winehouses and pubs. Some other neighborhoods around İstiklal Avenue have recently been revamped to cater to Beyoğlu's nightlife, with formerly commercial streets now lined with pubs, cafes, and restaurants playing live music. Other focal points for Istanbul's nightlife include Nişantaşı, Ortaköy, Bebek, and Kadıköy. Istanbul has some of Turkey's oldest sports clubs. Beşiktaş J.K., established in 1903, is considered the oldest of these sports clubs. Due to its initial status as Turkey's only club, Beşiktaş occasionally represented the Ottoman Empire and Turkish Republic in international sports competitions, earning the right to place the Turkish flag inside its team logo. Its football team has seen several periods of dominance in national competition. Galatasaray S.K. and Fenerbahçe S.K. have fared better in international competition and share the honor of winning the most Süper Lig championships: 20 and 19 times, respectively. Galatasaray and Fenerbahçe have a long-standing rivalry, with Galatasaray based in the European part and Fenerbahçe based in the Anatolian part of the city. Istanbul has seven basketball teams—Anadolu Efes, Beşiktaş, Darüşşafaka, Fenerbahçe, Galatasaray, İstanbul Büyükşehir Belediyespor and Büyükçekmece—that play in the premier-level Turkish Basketball Super League. Many of Istanbul's sports facilities have been built or upgraded since 2000 to bolster the city's bids for the Summer Olympic Games. Atatürk Olympic Stadium, the largest multi-purpose stadium in Turkey, was completed in 2002 as an IAAF first-class venue for track and field. The stadium hosted the 2005 UEFA Champions League Final. Şükrü Saracoğlu Stadium, Fenerbahçe's home field, hosted the 2009 UEFA Cup Final three years after its completion. Türk Telekom Arena opened in 2011 to replace Ali Sami Yen Stadium as Galatasaray's home turf, while Vodafone Arena opened in 2016 to replace BJK İnönü Stadium as the home turf of Beşiktaş, which won the Süper Lig in the same season. All four stadiums are elite Category 4 (formerly five-star) UEFA stadiums. The Sinan Erdem Dome, among the largest indoor arenas in Europe, hosted the final of the 2010 FIBA World Championship, the 2012 IAAF World Indoor Championships, and the 2011–12 Euroleague Final Four. Prior to the completion of the Sinan Erdem Dome in 2010, Abdi İpekçi Arena was Istanbul's primary indoor arena, having hosted the finals of EuroBasket 2001. Several other indoor arenas, including the Beşiktaş Akatlar Arena, have also been inaugurated since 2000, serving as the home courts of Istanbul's sports clubs. The most recent of these is the 13,800-seat Ülker Sports Arena, which opened in 2012 as the home court of Fenerbahçe's basketball teams. Despite the construction boom, five bids for the Summer Olympics—in 2000, 2004, 2008, 2012, and 2020—and national bids for UEFA Euro 2012 and UEFA Euro 2016 have ended unsuccessfully. Istanbul Park was a stop on the World Touring Car Championship circuit and the European Le Mans Series in 2005 and 2006, but the track has not seen either of these competitions since then. Between its opening in 2005 and 2011, Istanbul Park also hosted the annual Turkish Grand Prix; its future remains uncertain due to financial troubles. The Istanbul Sailing Club, established in 1952, hosts races, showcases, and events on the waterways in and around Istanbul each year. The Turkish Offshore Racing Club also hosts major races, with its most prestigious being its race for the Marine Forces Trophy. Istanbul was also an occasional stop on the F1 Powerboat World Championship circuit, although its last appearance on the Bosphorus was in 2000. Most state-run radio and television stations are based in Ankara, but Istanbul is the primary hub of Turkish media. The industry has its roots in the former Ottoman capital, where the first Turkish newspaper, Takvim-i Vekayi (Calendar of Affairs), was published in 1831. The Cağaloğlu street on which the newspaper was printed, Bâb-ı Âli Street, rapidly became the center of Turkish print media, alongside Beyoğlu across the Golden Horn. Today, Istanbul hosts a wide variety of periodicals. Most nationwide newspapers are based in Istanbul, with simultaneous Ankara and İzmir editions. Istanbul-based Zaman, although only founded in 1986, is Turkey's most widely circulated paper, with a weekly distribution of more than one million, twice that of its nearest competitor. Posta, Hürriyet, and Sözcü, which round out the country's top four papers, are all headquartered in Istanbul, boasting more than 300,000 weekly sales each. Hürriyet's English-language edition, The Hürriyet Daily News, has been printed since 1961, but the English-language Today's Zaman, first published by Zaman in 2007, has overtaken it in circulation. Several smaller newspapers, including popular publications like Habertürk and Milliyet, are also based in Istanbul. Radio broadcasts in Istanbul date back to 1927, when Turkey's first radio transmission came from atop the Central Post Office in Eminönü. Control of this transmission, and other radio stations established in the following decades, ultimately came under the state-run Turkish Radio and Television Corporation (TRT), which held a monopoly on radio and television broadcasts between its founding in 1964 and 1990. Today, TRT runs four national radio stations; these stations have transmitters across the country so each can reach over 90 percent of the country's population, but only Radio 2 is based in Istanbul. Offering a range of content from educational programming to coverage of sporting events, Radio 2 is the most popular radio station in Turkey. Istanbul's airwaves are the busiest in Turkey, primarily featuring either Turkish-language or English-language content. One of the exceptions, offering both, is Açık Radyo (94.9 FM). Among Turkey's first private stations, and the first featuring foreign popular music, was Istanbul's Metro FM (97.2 FM). The state-run Radio 3, although based in Ankara, also features English-language popular music, and English-language news programming is provided on NTV Radyo (102.8 FM). TRT-Children is the only TRT television station based in Istanbul. Istanbul is home to the headquarters of several Turkish stations and regional headquarters of international media outlets. Istanbul-based Star TV was the first private television network to be established following the end of the TRT monopoly; Star TV and Show TV (also based in Istanbul) remain highly popular throughout the country, airing Turkish and American series. Samanyolu TV, Kanal D, and ATV are other stations in Istanbul that offer a mix of news and series; NTV (partnered with U.S. media outlet MSNBC) and Sky Turk—both based in the city—are mainly just known for their news coverage in Turkish. The BBC has a regional office in Istanbul, assisting its Turkish-language news operations, and the American news channel CNN established the Turkish-language CNN Türk there in 1999. The Istanbul-based business and entertainment channel CNBC-e began broadcasting in 2000. Istanbul University, founded in 1453, is the oldest Turkish educational institution in the city. Although originally an Islamic school, the university established law, medicine, and science departments in the 19th century and was secularized after the founding of the Turkish Republic. Istanbul Technical University, founded in 1773, is the world's third-oldest university dedicated entirely to engineering sciences. These public universities are two of just eight across the city; other prominent state universities in Istanbul include the Mimar Sinan Fine Arts University, which served as Turkey's primary institution of art until the 1970s, and Marmara University, the country's third-largest institution of higher learning. Most established universities in Istanbul are backed by the government; the city also has several prominent private institutions. The first modern private university in Istanbul, also the oldest American school in existence in its original location outside the United States, was Robert College, founded by Christopher Robert, an American philanthropist, and Cyrus Hamlin, a missionary devoted to education, in 1863. The tertiary element of its education program became the public Boğaziçi University in 1971; the remaining portion in Arnavutköy continues as a boarding high-school under the name Robert College. Private universities were officially outlawed in Turkey before the Constitution of 1982, but there were already fifteen private "higher schools", which were effectively universities, in Istanbul by 1970. The first private university established in Istanbul since 1982 was Koç University (founded in 1992), and another dozen had opened within the following decade. Today, there are at least 30 private universities in the city, including Istanbul Commerce University and Kadir Has University. A new biomedical research and development hub, called Bio Istanbul, is under construction in Başakşehir, and will host 15,000 residents, 20,000 working commuters, and a university upon completion. In 2007, there were about 4,350 schools, about half of which were primary schools; on average, each school had 688 students. In recent years, Istanbul's educational system has expanded substantially; from 2000 to 2007, the number of classrooms and teachers nearly doubled and the number of students increased by more than 60 percent. Galatasaray High School, established in 1481 as the Galata Palace Imperial School, is the oldest high school in Istanbul and the second-oldest educational institution in the city. It was built at the behest of Sultan Bayezid II, who sought to bring students with diverse backgrounds together as a means of strengthening his growing empire. It is one of Turkey's Anatolian High Schools, elite public high schools that place a stronger emphasis on instruction in foreign languages. Galatasaray, for example, offers instruction in French; other Anatolian High Schools primarily teach in English or German alongside Turkish. The city also has foreign high schools, such as Liceo Italiano, that were established in the 19th century to educate foreigners. Kuleli Military High School, along the shores of the Bosphorus in Çengelköy, and Turkish Naval High School, located on one of the Princes' Islands, are military high schools, complemented by three military academies—the Turkish Air Force, Turkish Military, and Turkish Naval Academies. Darüşşafaka High School provides free education to children across the country missing at least one parent. Darüşşafaka begins instruction with the fourth grade, providing instruction in English and, starting in sixth grade, a second foreign language—German or French. Other prominent high schools in the city include Istanbul Lisesi (founded in 1884), Kabataş Erkek Lisesi (founded in 1908) and Kadıköy Anadolu Lisesi (founded in 1955). Istanbul's first water supply systems date back to the city's early history, when aqueducts (such as the Valens Aqueduct) deposited the water in the city's numerous cisterns. At the behest of Suleiman the Magnificent, the Kırkçeşme water supply network was constructed; by 1563, the network provided 4,200 cubic meters (150,000 cu ft) of water to 158 sites each day. In later years, in response to increasing public demand, water from various springs was channeled to public fountains, like the Fountain of Ahmed III, by means of supply lines. Today, Istanbul has a chlorinated and filtered water supply and a sewage treatment system managed by the Istanbul Water and Sewerage Administration (İstanbul Su ve Kanalizasyon İdaresi, İSKİ). The Silahtarağa Power Station, a coal-fired power plant along the Golden Horn, was the sole source of Istanbul's electricity between 1914, when its first engine room was completed, and 1952. Following the founding of the Turkish Republic, the plant underwent renovations to accommodate the city's increasing demand; its capacity grew from 23 megawatts in 1923 to a peak of 120 megawatts in 1956. Capacity declined until the power station reached the end of its economic life and shut down in 1983. The state-run Turkish Electrical Authority (TEK) briefly—between its founding in 1970 and 1984—held a monopoly on the generation and distribution of electricity, but now the authority—since split between the Turkish Electricity Generation Transmission Company (TEAŞ) and the Turkish Electricity Distribution Company (TEDAŞ)—competes with private electric utilities. The Ottoman Ministry of Post and Telegraph was established in 1840 and the first post office, the Imperial Post Office, opened near the courtyard of Yeni Mosque. By 1876, the first international mailing network between Istanbul and the lands beyond the Ottoman Empire had been established. Sultan Abdülmecid I issued Samuel Morse his first official honor for the telegraph in 1847, and construction of the first telegraph line—between Istanbul and Edirne—finished in time to announce the end of the Crimean War in 1856. A nascent telephone system began to emerge in Istanbul in 1881 and after the first manual telephone exchange became operational in Istanbul in 1909, the Ministry of Post and Telegraph became the Ministry of Post, Telegraph, and Telephone. GSM cellular networks arrived in Turkey in 1994, with Istanbul among the first cities to receive the service. Today, mobile and landline service is provided by private companies, after Türk Telekom, which split from the Ministry of Post, Telegraph, and Telephone in 1995, was privatized in 2005. Postal services remain under the purview of what is now the Post and Telegraph Organization (retaining the acronym PTT). In 2000, Istanbul had 137 hospitals, of which 100 were private. Turkish citizens are entitled to subsidized healthcare in the nation's state-run hospitals. As public hospitals tend to be overcrowded or otherwise slow, private hospitals are preferable for those who can afford them. Their prevalence has increased significantly over the last decade, as the percentage of outpatients using private hospitals increased from 6 percent to 23 percent between 2005 and 2009. Many of these private hospitals, as well as some of the public hospitals, are equipped with high-tech equipment, including MRI machines, or associated with medical research centers. Turkey has more hospitals accredited by the U.S.-based Joint Commission than any other country in the world, with most concentrated in its big cities. The high quality of healthcare, especially in private hospitals, has contributed to a recent upsurge in medical tourism to Turkey (with a 40 percent increase between 2007 and 2008). Laser eye surgery is particularly common among medical tourists, as Turkey is known for specializing in the procedure. Istanbul's primary motorways are the O-1, O-2, O-3 and O-4. The O-1 forms the city's inner ring road, traversing the 15 Temmuz Şehitler (First Bosphorus) Bridge, and the O-2 is the city's outer ring road, crossing the Fatih Sultan Mehmet (Second Bosphorus) Bridge. The O-2 continues west to Edirne and the O-4 continues east to Ankara; the O-2, O-3, and O-4 are part of European route E80 (the Trans-European Motorway) between Portugal and the Turkish–Iranian border. In 2011, the first and second bridges on the Bosphorus carried 400,000 vehicles each day. The Yavuz Sultan Selim (Third Bosphorus) Bridge entered service on 26 August 2016. Environmentalist groups worry that the third bridge will endanger the remaining green areas to the north of Istanbul. The three Bosphorus Bridges are currently the only road crossings between the Asian and European sides of Turkey. The dual-deck, 14.6-kilometer (9.1 mi) Eurasia Tunnel is currently under construction beneath the Bosphorus, between Fatih and Üsküdar. Istanbul's local public transportation system is a complex network of trams, funiculars, metro lines, buses, bus rapid transit, and ferries. Fares across modes are integrated, using the contactless Istanbulkart, introduced in 2009, or the older Akbil electronic ticket device. Trams in Istanbul date back to 1872, when they were horse-drawn, but even the first electrified trams were decommissioned in the 1960s. Operated by Istanbul Electricity, Tramway, and Tunnel General Management (İETT), trams slowly returned to the city in the 1990s with the introduction of a nostalgic route and a faster modern tram line, which now carries 265,000 passengers each day. The Tünel opened in 1875 as the world's second-oldest subterranean rail line (after London's Metropolitan Railway). It still carries passengers between Karaköy and İstiklal Avenue along a steep 573-meter (1,880 ft) track; a more modern funicular between Taksim Square and Kabataş began running in 2006. The Istanbul Metro comprises five lines (the M1, M2, M3 and M6 on the European side, and the M4 on the Asian side) with several other lines (such as the M5, M7, and M8) and extensions under construction. The two sides of Istanbul's metro are connected under the Bosphorus by the Marmaray tunnel, inaugurated in 2013 as the first rail connection between Thrace and Anatolia. With the Marmaray's completion, rail use in the city is expected to increase to 28 percent (from 4 percent), behind only Tokyo and New York City. Until then, buses provide transportation within and between the two halves of the city, accommodating 2.2 million passenger trips each day. The Metrobus, a form of bus rapid transit, crosses the Bosphorus Bridge, with dedicated lanes leading to its termini. İDO (Istanbul Seabuses) runs a combination of all-passenger ferries and car-and-passenger ferries to ports on both sides of the Bosphorus, as far north as the Black Sea. With additional destinations around the Sea of Marmara, İDO runs the largest municipal ferry operation in the world. The city's main cruise ship terminal is the Port of Istanbul in Karaköy, with a capacity of 10,000 passengers per hour. Most visitors enter Istanbul by air, but about half a million foreign tourists enter the city by sea each year. International rail service from Istanbul launched in 1889, with a line between Bucharest and Istanbul's Sirkeci Terminal, which ultimately became famous as the eastern terminus of the Orient Express from Paris. Regular service to Bucharest and Thessaloniki continued until the early 2010s, when the former was interrupted for Marmaray construction and the latter was halted due to economic problems in Greece. After Istanbul's Haydarpaşa Terminal opened in 1908, it served as the western terminus of the Baghdad Railway and an extension of the Hejaz Railway; today, neither service is offered directly from Istanbul. Service to Ankara and other points across Turkey is normally offered by Turkish State Railways, but the construction of Marmaray and the Ankara-Istanbul high-speed line forced the station to close in 2012. New stations to replace both the Haydarpaşa and Sirkeci terminals, and connect the city's disjointed railway networks, are expected to open upon completion of the Marmaray project; until then, Istanbul is without intercity rail service. Private bus companies operate instead. Istanbul's main bus station is the largest in Europe, with a daily capacity of 15,000 buses and 600,000 passengers, serving destinations as distant as Frankfurt. Istanbul has two international airports. The larger is Istanbul Atatürk, 24 kilometers (15 mi) west of the city center. It handled 61.3 million passengers in 2015, making it the third-busiest airport in Europe and the eighteenth-busiest in the world. Sabiha Gökçen International, 45 kilometers (28 mi) southeast of the city center, opened in 2001 to relieve Atatürk. Dominated by low-cost carriers, Istanbul's second airport has rapidly become popular, especially since the opening of a new international terminal in 2009; the airport handled 14.7 million passengers in 2012, a year after Airports Council International named it the world's fastest-growing airport. Atatürk has also experienced rapid growth, as its 20.6 percent rise in passenger traffic between 2011 and 2012 was the highest among the world's top 30 airports. Because of the traffic at Istanbul's current airports, a third international airport is planned for the Black Sea coast. Building a new runway at Atatürk Airport was rejected due to the cost involved; environmental concerns have also been raised with respect to the new airport. Currently under construction, the new international airport will become the largest airport in the world upon the completion of all four stages of the project, with a capacity to serve 150 million passengers per year. Sister and twin cities - Historic Areas of Istanbul, a World Heritage Site - The foundation of Byzantion (Byzantium) is sometimes, especially in encyclopedic or other tertiary sources, placed firmly in 667 BCE. Historians have disputed the precise year the city was founded. Commonly cited is the work of 5th-century-BC historian Herodotus, which says the city was founded seventeen years after Chalcedon, which came into existence around 685 BCE. Eusebius concurs with 685 BCE as the year Chalcedon was founded, but places Byzantion's establishment in 659 BCE. Among more modern historians, Carl Roebuck proposed the 640s BCE and others have suggested even later. The foundation date of Chalcedon is itself subject to some debate; while many sources place it in 685 BC, others put it in 675 BC or even 639 BCE (with Byzantion's establishment placed in 619 BCE). Some sources refer to Byzantium's foundation as the 7th century BCE. - The name Istanbul has been in use since before the 1453 Ottoman conquest, but in English Istanbul became common only after Turkey adapted the Latin alphabet in 1928 and urged other countries to use the city's Turkish name.</ref>Districts 39Government • Mayor Kadir Topbaş (AKP)Area • Urban 1,539 km2 (594 sq mi) • Metro 5,343 km2 (2,063 sq mi)Elevation 39 m (128 ft)Population (31 December 2015) • City 14,025,646 • Rank 1st • Urban 14,100,000 • Metro 14,657,434 • Metro density 2,691/km2 (6,970/sq mi)Demonym(s) ConstantinopolitanTime zone EET (UTC+2) • Summer (DST) EEST (UTC+3)Postal code 34000 to 34990Area code(s) 0212 (European side) 0216 (Asian side)Vehicle registration 34Nominal GDP 2012 - Total $301 billion<ref name='brookings.edu'>https://www.brookings.edu/wp-content/uploads/2016/07/Istanbul-1.pdf - Sources have provided conflicting figures on the area of Istanbul. The most authoritative source on this figure ought to be the Istanbul Metropolitan Municipality (MMI), but the English version of its website suggests a few figures for this area. One page states that "Each MM is sub-divided into District Municipalities ("DM") of which there are 27 in Istanbul" [emphasis added] with a total area of 1,538.9 square kilometers (594.2 sq mi). The Municipal History page appears to be the most explicit and most updated, saying that in 2004, "Istanbul Metropolitan Municipality's jurisdiction was enlarged to cover all the area within the provincial limits". It also states a 2008 law merged the Eminönü district into the Fatih district (a point that is not reflected in the previous source) and increased the number of districts in Istanbul to 39. That total area, as corroborated on the Turkish version of the MMI website, and a Jurisdiction page on the English site is 5,343 square kilometers (2,063 sq mi). - Historians disagree—sometimes substantially—on population figures of Istanbul (Constantinople), and other world cities, prior to the 20th century. A follow-up to Chandler & Fox 1974,Chandler 1987, pp. 463–505 examines different sources' estimates and chooses the most likely based on historical conditions; it is the source of most population figures between 100 and 1914. The ranges of values between 500 and 1000 are due to Morris 2010, which also does a comprehensive analysis of sources, including Chandler (1987); Morris notes that many of Chandler's estimates during that time seem too large for the city's size, and presents smaller estimates. Chandler disagrees with Turan 2010 on the population of the city in the mid-1920s (with the former suggesting 817,000 in 1925), but Turan, p. 224, is used as the source of population figures between 1924 and 2005. Turan's figures, as well as the 2010 figure, come from the Turkish Statistical Institute. The drastic increase in population between 1980 and 1985 is largely due to an enlargement of the city's limits (see the Administration section). Explanations for population changes in pre-Republic times can be inferred from the History section. - The United Nations defines an urban agglomeration as "the population contained within the contours of a contiguous territory inhabited at urban density levels without regard to administrative boundaries". The agglomeration "usually incorporates the population in a city or town plus that in the suburban areas lying outside of, but being adjacent to, the city boundaries". Figures dated 1 July 2011 place the populations of the agglomerations of Moscow and Istanbul at 11.62 million and 11.25 million, respectively. The UN estimates that the agglomeration of Istanbul will exceed the agglomeration of Moscow in population by 2015 (with 12.46 million and 12.14 million, respectively), although extrapolation suggests that the former will not surpass latter until the second half of 2013. A revision with 2013 data is due in the first half of 2014. - UEFA does not apparently keep a list of Category 4 stadiums, but regulations stipulate that only these elite stadiums are eligible to host UEFA Champions League Finals, which Atatürk Olympic Stadium did in 2005, and UEFA Europa League (formerly UEFA Cup) Finals, which Şükrü Saracoğlu Stadium did in 2009. Türk Telekom Arena is noted as an elite UEFA stadium by its architects. - Room 2006, pp. 177 - "City mayors:Largest cities in the world by land area, population and density". citymayors.com. 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Suddenly, we noticed that police officer under the overhead bridge a few hundred metres ahead. He has a gun; speed gun lah. What do we do? Quickly look at the speed which we were driving and quickly slow down? Haha. If we had followed the speed limit, why need to be worried or scared and having to take immediate actions? Alternatively, just keep speeding and just pay the speed fine later on lah. 🙂 It’s just a few hundred ringgit anyway. Well, what happens then if someone were to call us and tells us that we owe him some unpaid fees and he is going to sue us to bankruptcy unless we pay them back soonest possible? Would we transfer money to his bank account or do we get some proofs first? What if he’s angry and threatened us back when we ask for more details? Are there people whom we could ask? At least some friends who are more knowledgeable then us? Surely there are many. Anyway, some chose to just pay and pay and well, pay. Article in freemalaysiatoday.com A 66-year old woman was duped by scammers pretending to be police officers. According to the police (the real ones), she lost RM618,302.58 to the scammer. Basically, the scammer managed to get her to apply for an ATM card as well as an online banking password. Three weeks later, the money in the account was emptied. She actually sent the ATM card to the scammers earlier. How it happened: Central Seberang Perai police chief Nik Ros Azhan Nik Abdul Hamid said the victim received a phone call on Dec 11 from a “Pos Laju officer” in Kuantan, claiming that her parcel to Miri, Sarawak, had been quarantined. She was then connected to a woman who’s a high ranking officer in Kuantan police headquarters who told her that she would be investigated for money laundering. The victim did everything that she was told… More details in the Article in freemalaysiatoday.com By the way, the article in freemalaysiatoday.com did not explain very clearly. However, this is not even the main point. The main point is this, how could the scammers be so good with their game plan? Actually, it’s a probability game for them. They do their best to keep calling. Once they hit a victim who is willing to do what they say, they get a few hundred thousand ringgit and they will continue their calling and fooling. Secondly and more importantly, why did the victims become the victims? Surely they would have read somewhere about all these scams? Well, that’s why I kept writing and doing my best to keep telling people that all these are purely scams and nothing more. Any formal notifications will have be done formally. It cannot be through a call where they guided us to give them our password or even to apply for an ATM card and to send it to them… Perhaps it’s even better NOT to do something which we know is illegal yeah. Happy understanding. Next suggested article: Cheated again, yet again, always. Sigh…

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Recently, it has been mostly negative news if any when it comes to Malaysia. From oil prices affecting the economy to oil prices affecting the currency and to oil prices affecting even the Malaysian economy, everything is about how oil prices is wrecking havoc. Even with the decreasing petrol prices, all the restaurants have shown that once prices are up, nothing will come down. Yet, as usual, these popular places continue to be patronised by the so-called ‘poorer’ Malaysians. Fortunately, FORTUNE magazine released its latest top 7 best markets to invest in the category of emerging economies. Malaysia is ranked in these top 7 countries and they include others like India, Indonesia, Mexico, Colombia, Poland and Kenya. This is what they said about us. The current government scrapped fuel subsidies and will introduce a 6% Goods and Services Tax in April which will improve the fiscal position of the country. More foreign investors will be enticed with Najib’s Economic Transformation Program through further tax incentives for foreign investors. The manufacturing and the financial services sector will be liberalised further. As the slowdown is continuing in the region, especially China, the Malaysian government will have to continue spending to boost infrastructure, education and health care. Balancing the budget continue to be on the agenda with a final target of a balanced budget by 2020. Okay, assuming Fortune is right and they managed to also convince some of these foreign investors to think Malaysia, what should we do? Well, I think it’s time we think harder on where we may want to invest our money in. Properties? Probably. Share market, most probably. Other investments? Yeah, as long as you believe that it would give you better returns than just leaving the money in savings account or even Fixed Deposits which will remain low because Bank Negara Malaysia is likely to maintain the borrowing costs until end of 2015. If you do not believe Fortune’s selection of Malaysia? Well, there are still another 6 other countries which Fortune is touting as worth a serious look. Of course, if these 6 are also not your cup of tea, there are still over one hundred countries in the world which we can move our money to. Just have to choose a few and stick to it for these 5 years and change later. Happy investing. written on 31 Jan 2015 Next suggested article: Switching for better investment, always.

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The rechargeable battery also offers you 5.0 amp-hours of runtime. Each battery pack is durably built for heavy-duty use, runs cooler, and performs in climates below 0°F/-18°C. This protection routes water away from the electronics and out of the battery pack, extends your battery's run-time and life by minimizing heat, and prevents pack failures from vibration or drops. Built-in REDLINK Intelligence protects the battery from overloads, preventing you from damaging your cordless power tools in heavy-duty situations, while the discharge protection prevents cell damage. An integrated temperature management system and individual cell monitoring help to maximize your battery's life. Switch to our REDLITHIUM XC5.0 Battery Pack to instantly upgrade the runtime and durability of your Milwaukee M18 cordless tools. The item "Brand New Milwaukee M18 Cordless 4-1/2 Cut-off Grinder Battery 48-11-1850" is in sale since Monday, February 15, 2021. This item is in the category "Home & Garden\Tools & Workshop Equipment\Power Tools\Grinders". The seller is "chrs6733" and is located in Gaithersburg, Maryland. This item can be shipped to United States, Canada, United Kingdom, China, Mexico, Germany, Japan, France, Australia, Russian federation, Denmark, Romania, Slovakia, Bulgaria, Czech republic, Finland, Hungary, Latvia, Lithuania, Malta, Estonia, Greece, Portugal, Cyprus, Slovenia, Sweden, South Korea, Indonesia, Taiwan, South africa, Thailand, Belgium, Hong Kong, Ireland, Netherlands, Poland, Spain, Italy, Austria, Bahamas, Israel, New Zealand, Philippines, Singapore, Switzerland, Norway, Saudi arabia, Ukraine, United arab emirates, Qatar, Kuwait, Bahrain, Croatia, Malaysia, Chile, Colombia, Costa rica, Dominican republic, Panama, Trinidad and tobago, Guatemala, El salvador, Honduras, Jamaica, Antigua and barbuda, Aruba, Belize, Dominica, Grenada, Saint kitts and nevis, Saint lucia, Montserrat, Turks and caicos islands, Barbados, Bangladesh, Bermuda, Brunei darussalam, Bolivia, Egypt, French guiana, Guernsey, Gibraltar, Guadeloupe, Iceland, Jersey, Jordan, Cambodia, Cayman islands, Liechtenstein, Sri lanka, Luxembourg, Monaco, Macao, Martinique, Maldives, Nicaragua, Oman, Pakistan, Paraguay, Reunion, Uruguay.

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- This design is inspired by the traditional selepang (sash) worn by fashionable Malay women over their shoulder in the olden days. To give it a modern spin, we added another sash that can be tucked and shaped to form a sophisticated knot at the front of the blouse. - The sashes are made from medium-weight jacquard with a gold MQ brand logo sewn at the tip while the blouse and mermaid skirt are made of lightweight satin. - The sash that goes over the shoulder is secured into place by hand stitching. The other sash is free for you to tuck under (the first sash) and tighten as you please to determine the tension of the knot. - As always, our sets can be worn separately long past the festive season. The top can be worn with denim jeans, pants or a casual skirt. And the skirt can be paired with other dressy tops or a crisp white shirt. Sales items are non-exchangeable or refundable. All sales are final. For measurements, please click on the link at the start of this product page that says "SIZE CHART" to view the measurements. Note that they are of the apparel when laid flat. There might be slight differences from apparel to apparel as they are cut and sewn by hand by our artisans. If you are uncertain about the size, please email us email@example.com or WhatsApp us +65 8356 9355

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Updated: February 9, 2021 Dateline: Mexico City, Mexico Dual citizenship can be a very exotic idea for many people. It’s mystical enough that when these people first find Nomad Capitalist while looking for second passport options, they have a hard time figuring out the logistics of something that seems so obscure. “How do I travel with my second passport?” they ask. “How do I manage having two, three, or even four passports?” they wonder. “What kind of problems is this going to cause and how do I avoid them?” is a common concern. These questions can sometimes feel overwhelming. But, with a little bit of knowledge, most people find that there are pretty straightforward answers. Here at Nomad Capitalist, we have the answers and knowledge that you’re looking for. In this article, we’ll cover which passports will help simplify your travel and what problems you should look out for while traveling. PASSPORTS AND FLAG THEORY Now, if you’ve kept up with Nomad Capitalist and have read at least a few of our articles or watched some of our videos on the subject, you know that my approach to citizenship is a little different from that of other people. The traditional dual citizen that people see on YouTube or Instagram is a Canadian or a US citizen that has branched out to explore somewhere else. Perhaps they had a grandparent from Ireland or another ancestor from Italy or Poland and picked up their second citizenship through descent. This person now has two passports that allow them to travel visa-free around the European Union (EU) and North America. At this point, they’re basically traveling back and forth between the two regions, living in one and visiting the other. This is a relatively straightforward way of handling having two passports. If you can get a European passport through ancestry, that’s fine. In the long term though, having a European passport may be a negative for your tax strategy. However, if you can get a free passport, you should take the opportunity while you can. What I’m concerned with, and what we look into here at Nomad Capitalist, is how you can get and use passports to support your financial strategy and nomadic lifestyle — meaning passports that you can obtain from a country that you can use as a base in your international strategy to go where you’re treated best. This means looking at all the available options that will best suit your needs rather than simply picking a place that sounds nice and trying to make it work. As far as traveling is concerned, this involves knowing what kind of opportunities for visa-free travel are available through each citizenship. To this end, we’ve created the Nomad Passport Index to help our readers. Not only does the index account for visa-free travel but it also considers factors such as taxes and public perception to better inform you of a passport’s true value based on your personal situation and needs. We have also created a tiered system to break down the quality of travel available with each passport. For this article, we’ll focus on these three tiers: - Tier A Passports: Since the United States is the most difficult country to get into, Tier A passports are from countries that have visa-free access to the US as part of the US Visa Waiver Program. This is a very short list. - Tier B Passports: These passports allow those carrying them to visit Europe’s Schengen Area without a visa. Europe is much more lenient than the US, but still not freely open to every passport holder. - Tier C Passports: These passports are much more limited and do not allow visa-free access to the US or the EU. The traditional example of a dual citizen is someone with two Tier A passports that has a relatively simple way of getting back and forth between destinations. The catch is that those two Tier A passports come with tax burdens and other potential downsides that may not make the benefits of having those two passports worth it. These people will potentially have or want a series of Tier B passports that allow them a wide variety of opportunities, but with less of the drawbacks they want to avoid. Having renounced my US citizenship, I now use a portfolio of Tier B passports that give me almost the same amount of visa-free travel as my old US passport. It’s a solution that truly allows me to go where I’m treated best. COMMON TRAVEL COMPLICATIONS WITH MULTIPLE PASSPORTS Whether you have two Tier A passports, a combination of Tier A and something else, or a portfolio of Tier B passports, you will certainly run into a few common complications when traveling with two passports. The following are the issues my team, my clients, and I commonly face while traveling from country to country: Juggling Passports with Airlines and Immigration The first thing to consider is what you’re telling the airline (or whatever other method of travel you’re using) when you’re traveling between countries. Some people worry that the airline is going to hover over them, making sure that whatever passport they entered in the airline’s database is the passport they’re going to use. In reality, this isn’t the case. The airline’s job is to make sure that you aren’t going to be denied entry into the next country. They aren’t worried about what passport you use to get through immigration. They just want to make sure that they don’t have to get you back after you’ve been denied entry. Customs, on the other hand, is the exact opposite. If you live in the United States, you’re supposed to enter and exit with your US passport. They don’t want you to come in as a German or Norwegian citizen if you have a US passport. While there aren’t any exit controls, they want you to leave as a US citizen as well. They want this because, for all intents and purposes, they consider you their citizen on their soil and no one else’s. And the same thing happens if you travel to the EU. They still view you as their citizen, no matter what other travel documents you may have. All in all, this is not as huge of an issue as it may seem at first. Each group will expect the appropriate passport and, as long as you present the documents that airlines and customs are each expecting, you shouldn’t be held up. If you aren’t a citizen of one or both of the countries you’re traveling through, the same principle applies. Show whichever passport is most suitable to the airline you’re traveling with so they know you won’t be denied entry. Then, show customs officers whichever passport will allow you to pass through freely. Nothing too complicated, especially if you’ve done your research beforehand. Residencies and Traveling Another thing to pay attention to as you travel is if you’re going through a country where you have a residency permit. What passport you use while traveling through these countries can be potentially helpful or hurtful. For example, if I’m going to Malaysia, I’m going to advise the airline of the passport I have that has my ten-year Malaysian sticker visa in it — just to make things easy and straightforward. At the end of the day, it might not make a huge difference to the airline which of my passports I use as long as I can get in visa-free. The problem that could come up, however, is that entering Malaysia on another passport may invalidate my sticker visa. Mexico is another country where this could be a problem. If I have a Mexican residence permit associated with one of my passports but enter on another, it will immediately nullify my residence permit. The solution here is to understand the terms of entry to these countries. Mexico and Malaysia don’t really care which passport you use to enter. You’ll only have problems if there’s some other kind of immigration status to be concerned with. As long as you keep straight which passport will admit you when you get there and understand the rules of the country you’re going to, this won’t be a problem. Passports, Privacy Concerns, and Dual Citizen Restrictions Privacy is something you’ll also want to keep in mind when it comes to restrictions on your dual citizenship status, more so for travelers who aren’t citizens of western countries. There are certain countries where you have to report dual citizenship and other countries where you aren’t allowed dual citizenship. India, for example, only allows a very select few to have dual citizenship. What’s often advised is if you have a second passport and want to retain your Indian passport is to always travel through a third country. In this situation, you would fly from India to somewhere where Indians have visa-free travel and then switch in that country to your second passport. By doing this, there will be no record of your second passport in the Indian immigration system. That being said, if you find yourself in a situation like this, you’ll want to take the time to get all the information you can from the people who helped you get the passport as well as lawyers in your own country. I personally don’t want to advise on something where you are potentially going to get in trouble at home by not reporting other citizenships. Again, this isn’t normally an issue for westerners, but it can be for a few countries, including China. What you should be aware of is that whatever passport you use with the airline database or to get through customs and immigration may go into a system that allows other groups to see what passports you have used as you traveled. Any airline that flies into the United States, for example, is required to share its passenger data. You have to be careful how you enter and exit a country and how you’re representing yourself to the airline if you have a passport that you’re worried about. There are certainly privacy concerns here, but the reality of the situation is that a lot of data is being shared across borders. Increasingly, countries will be asking you what passports you hold. Whether it’s Electronic System for Travel Authorization (ESTA) or the Electronic Travel Information System (ETIS) in the European Union, there is going to be much less privacy around citizenships in the coming years. If you’re traveling with multiple passports, the big issue will be being cognizant of any potential problems or issues that can come up that could endanger your dual citizenship. CAN A SECOND PASSPORT GIVE YOU A TRAVEL LOOPHOLE? There are actually two definitions for “second passport.” In one case you have two passports from two different countries where you have citizenship. The other case would be if you had two passports from the same country for whatever reason — say one of your passports was in an embassy getting a visa sticker so you got a second passport from your country so that you could continue to travel. I get asked questions about whether you can travel in a different way, have more travel privileges or break some of the rules by having either type of second passport. People have asked if there are legal loopholes that having two travel documents can afford you. Of course there are some privileges that come with a second passport. Having two citizenships means you have two travel documents. If one of your countries has some kind of problem it can affect your travel options. We have been seeing this during the COVID-19 pandemic. Persons from certain countries were refused entry when traveling to other countries. If you were Chinese and you were trying to enter a country, it didn’t matter if you didn’t actually live in China, some countries were turning away all Chinese citizens. Additionally, not every passport can get into every country. Most Western passports have pretty good visa-free travel, but you probably can’t use them to get into Russia or China. If you have passports from two different countries it can expand your options for travel and business. It’s a good diversification strategy overall. But other than these benefits, people want to know if a second passport can provide a kind of travel loophole. Many want to know if you have two passports that both give access to the Schengen area in Europe if they can use the two different passports to extend their stay. For example, an American passport gives them 90 days out of the overall 180 days that they can spend in the Schengen area. The theory is that a second citizenship from another country that also has access to the Schengen area can provide an additional 90 days. Could they use these two passports to go to the Schengen area visa-free for 90 days with their American passport and then leave, turn around and come back with their St. Lucian passport for another 90 days visa-free? Other people have asked if they have a US passport and got a second US passport that has a different number, could they do the same thing where they leave and then come back and reenter the area using the other passport to get more visa-free travel. While there are still a lot of countries that don’t do biometrics and some that still don’t take your photo, most countries keep good records. When you go to a country, they scan your passport. Many countries now require biometric passports. They’re going to look at your name, date of birth, and photo and they’ll keep that on record. Sometimes they’ll capture your fingerprints or make sure they have photos. If you leave a country and come right back on a different passport, there are certain countries that may not mind. Certain countries will let you in as long as you’re respecting their visa rules. Let’s say you get 30 days or 90 days visa-free, if you leave every 30 or 90 days and come right back, some countries don’t care if you do that over and over again with the same passport. They can’t let you overstay but as long as you’re coming and going it’s fine. But other countries have a rule like 90 per 180 or 30 per 365. For example, Colombia has a 90 per 180 rule, meaning you can only spend up to 90 days in a 180 day period there, regardless of the number of entries. For those countries, it’s generally inadvisable to try and trick them by reentering with a different passport. If a country says you have visa-free access for 90 days out of every 180 days — this is the rule in the Schengen area — they aren’t talking about the passport, they’re talking about the person. You can’t use all your different passports to come and go. Many countries have interesting residence permit options. If you want to spend full time there I would recommend getting a residence permit or even citizenship in the country you want to live in rather than trying to trick them with two separate passports. Many people view dual citizenship and traveling with two passports as something exotic, but what they don’t realize is that it’s really just a practical issue with a practical solution. That solution breaks down into two simple ideas: - Enter and exit a country on its own passport, wherever possible. - Present yourself and your documents in the most practical and suitable way possible as you travel. Depending on the reason that you have that second passport, this will look very different in each situation. If you have a US passport along with a Tier B passport that you picked up through economic citizenship as a Plan B, you’ll probably still use the US passport in most emerging countries if both provide you the same visa-free access. If you have two passports (or a portfolio of passports) from nations that are very geopolitically different, like Montenegro and Serbia, appropriately using each of those passports will allow you to gain visa-free access to parts of the world you wouldn’t have on each one individually. Sometimes these benefits are much smaller. For example, you can get into Armenia with either a US or St. Lucia passport, but the US passport will get you through faster with fewer questions. In other countries, being a US citizen may not be as favorable. All in all, if you’re able to create a true, cohesive story about who you are, where you’re from, where you’re going, and why you should be welcomed there, life is going to be much easier. In my experience, the more disjointed your story, the slower and more complicated your travel will be.

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This register seeks to provide participants with a record of approved gear for usage in Malaysia and Singapore. General – MRA Regulation 1.13 (a) Any additional gear not referred to in the regulations, shall not be worn by a horse in a race without the prior written approval and permission of the Stipendiary Stewards. (b) Any gear approved and used on a horse in a race shall continue to be used on that horse without variation until permission to the contrary has been obtained from the Stipendiary Stewards. (c) The Stipendiary Stewards may inspect any saddlery, general equipment and gear which is to be carried in a race. Any defective equipment found may be confiscated. (d) No person shall use or attempt to use defective equipment in a race. The person having charge of an Apprentice in a particular race shall be responsible for ensuring that such Apprentice’s equipment is not defective. (e) When any horse is equipped in a way which may, in their opinion, be harmful to a horse in a race or when such equipment may, in their opinion, adversely affect the running of such horse, the Stipendiary Stewards may: (1) Order the equipment concerned to be replaced or removed; (2) Withdraw the horse from the race.

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Lewis Hamilton has broken Michael Schumacher’s record for most pole positions. When might Schumacher’s other major achievements be eclipsed? Michael Schumacher was on Sebastian Vettel’s mind after the Ferrari driver scored his first win for the team in Malaysia today. Michael Schumacher’s manager has issued a statement confirming the seven-times world champion has returned home from hospital, nine months after suffering serious head injuries in a skiing accident. Michael Schumacher’s manager has announced that the former world champion is now out of the medically-induced coma that doctors placed him into following a serious skiing accident. Michael Schumacher is showing signs of awakening from the coma he has been in for over three months, according to his agent. Michael Schumacher’s spokesperson Sabine Kehm says there are “small, encouraging signs” he is beginning to emerge from the coma he has been in for over 14 weeks. Video filmed by a camera mounted on Michael Schumacher’s helmet at the time of his skiing crash has confirmed further details of his accident. Doctors treating Michael Schumacher at a hospital in Grenoble say his condition has improved following a second operation on his head injuries last night. Michael Schumacher remains in a “very serious” condition following the head injuries he suffered while skiing in France yesterday. Michael Schumacher says he’s glad he doesn’t have Sebastian Vettel for a team mate after the Red Bull driver’s dominant form against team mate Mark Webber. Michael Schumacher believes Mercedes’ second place in the constructors’ championship shows they can compete for the title next year. Fernando Alonso is an even stronger team mate than Michael Schumacher was, according to Felipe Massa. This Ferrari F310B which was driven by Michael Schumacher during the 1997 season is set to go on sale at auction next month. Pictures of Michael Schumacher lapping the Nurburgring Nordschleife in a Mercedes Formula One car today. Michael Schumacher will get back behind the wheel of an F1 car on the Nurburgring Nordschleife next month, Mercedes has confirmed. Michael Schumacher will race his former team mate Jos Verstappen’s 15-year-old son as he makes a comeback in karts this weekend. Look back on Michael Schumacher’s three-year F1 comeback with Mercedes in this collection of 66 pictures. Was Michael Schumacher’s three-year comeback a complete write-off? Greg Morland picks ten of his best moments for Mercedes. The Brazilian Grand Prix saw the end of an era as Michael Schumacher retired from Formula One. Championship contenders Sebastian Vettel and Fernando Alonso paid tribute to outgoing seven-times world championship Michael Schumacher in Brazil.

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Newsletter Vol. 1 Issue 2 Scientific & Technical Research Association Dear STRA Members, Thank you for your interest and support in our organization. STRA now has over 5256 members from 45 countries. We are happy to launch our first newsletter for our Association. Here are some of the glimpses of our current and upcoming endeavors. STRA has successfully organised following International conferences in the period of Aug-Nov 2016: - 21-22 July 2016, PAUM Club House, University of Malaya, Kuala Lumpur, Malaysia - 01-02 September 2016, Yildiz Technical University, Istanbul, Turkey - 20-21 September 2016, Imperial College London, South Kensington Campus, London, UK - 20-21 October 2016, Regal Oriental Hotel, Kowloon, Hong Kong - 10-11 November 2016, Nanyang Technological University, Singapore We thank all members, participants and supporting organisations for making these conferences successful. It is our constant endeavour to associate with academicians, researchers, students, professionals and organisations. This collaboration is the crux of our growth and contribution to the society. We are proud to have following organisational collaborations: - Nanyang Technological University, Singapore (Venue Provider) - Yildiz Technical University, 34349 Beşiktaş, Istanbul, Turkey (Venue Provider) - Rumah University, University of Malaya, Kuala Lumpur, Malaysia (Venue Provider) - Buein Zahra Technical University, Iran (Collaboration) - Research and Markets Limited, Dublin, Ireland (Collaboration) - CNKI (China National Knowledge Infrastructure), China (Collaboration) - International Journal of Computer Science and Business Informatics (IJCSBI), Mauritius (Collaboration) - Linton University College, KTG Group, Malaysia (Collaboration) - Asian Institute of Technology (AIT), Conference Center, Bangkok, Thailand (Venue Provider) - Peacful Mind Foundation, India (Partner) - Tresorix Ltd. Mauritius (Collaboration) - ResearchSEA, Asia Research News, UK (Media Partner) - International Journal of Learning, Teaching and Educational Research, Mauritius (Collaboration) - International Journal of Supply Chain Management (Scopus indexed), London (Collaboration) - GTIS, Taiwan (Green Technology Invention Society, Taiwan) (Collaboration) - Tecnico (Universidade de Lisboa), Campus da Alameda, Lisbon, Portugal (Venue Provider) - Srishti International, Bangalore, India (Collaboration) - Universitat de Barcelona, Barcelona, Spain (Venue Provider) - Kasetsart University, KU Home, Bangkok, Thailand (Venue Provider) We will be glad to partner with your organisation. Please write to email@example.com for assistance. STRA is searching for talented and energetic conference coordinators (part-time) who are working/ studying at following locations: Dubai/ London/ Barcelona/ Lisbon/ Rome/ Kuala Lumpur/ Bali/ Singapore/ Bangkok Its a golden opportunity to be a part of our global team, to interact and associate with International academicians, display your leadership and organising skills and earn handsome honorarium. All interested and eligible candidates are requested to contact us with their CV, Photograph, Cover Letter on firstname.lastname@example.org Graduate School of Global Environmental Studies Kyoto University, Japan Title: Ecological Sanitation and its Role in Society Ecological sanitation (eco-san) is defined as the system that prevents disease and promotes health; protects the environment and conserves water; recovers and recycles nutrients and organic matter to soil. The basic principle of eco-san is to close the loop between sanitation and agriculture. Closing the loop means making availability of nutrients that may have been lost if urine and fecal matter is buried and never reused. The area where there is no proper drainage facility, where water scarcity problem is major problem and where infertility of soil hinders production, ecological sanitation would be a good option. The urine and excreta is no more waste but is used as a potential resource for agriculture. So, the system is also called as productive sanitation due to its role on production. The research done in past in countries of Africa and Asia showed the positive impact of ecological sanitation in reducing diseases and reducing poverty. Although the cases might be found that the people hesitate to work with owns urine and excreta. But the knowledge on eco-san manure and its role on productivity helped to reduce their hesitation to work with eco-san manure. For my research/study during Kyoto University, the rural village of Nepal was chosen because of all above circumstances and the need to find out the solution to these problems in the reason. The eco-san toilet was installed to spread its benefits to the local people.

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March 2021 Update After our last update in November 2020, our new COP26 National Working Group has been hard at work with events, campaigns, collaborations, and everything climate! Read below what we’ve been up to, what’s coming up, and how you can get involved… Our work so far There have been a number of exciting updates from our teams, as we’ve focussed on delivering national campaigns, webinars, and projects: - COP26 Letter Campaign In December 2020, alongside MedAct, Health Declares, and the Centre for Sustainable Healthcare, we launched our letter to the government calling on them to prioritise the health of people and planet at COP26 this year! To date, it’s received an incredible 1300+ signatures and support from several Royal Colleges, such as the RCGP, RCP and RC Psych, as well as featured in the BMJ! The voice of the medical community is hugely influential and we demand the government shows leadership in its climate action. If you haven’t already – add your name to the letter here. - Climate Justice Webinar Series Earlier this year, we hosted a webinar series focusing on global health and climate justice. It’s been a big success, with over 40 people attending every webinar! There have been some inspiring speakers and topics, so make sure you catch up on our YouTube channel to not miss out! - Show the Love Campaign Being part of The Climate Coalition, we joined this year’s annual campaign called Show The Love. The aim is to use the power of green hearts to join together and urge politicians to prioritise the climate! We ran a series of regional training sessions called ‘Climate Change and Health 101’, with loads of people attending across the UK! It is so exciting to see so many people take part and the feedback we received has been very positive. The Climate Coalition has also published a report on the impact of climate change on our health. You can read the report here! - Collaboration with Klima Action Malaysia and Germinis We have teamed up with Klima Action Malaysia (KAMY) and Germinis for the project ‘Weaving Hopes for the Future’, which will showcase artwork from indigenous Malaysian communities at COP26. It has been even more exciting to secure a grant from the British Council to help run this amazing initiative. Our NWG Chair, Amit, worked alongside Germinis and KAMY to pitch to key stakeholders at the British Council Malaysia Pitching event. The project even made it into the Malaysian news! Click here to read the article. - Climate Change on the Curriculum (CConC) We’ve launched our Climate Change on the Curriculum initiative – aiming for better representation of climate change on medical school curricula. We’ve already recruited a fantastic team of Climate Reps from universities across the UK and are holding training sessions on how to push for changes at university. We’re still looking for enthusiastic members to join our team so if you’d like to get involved, email email@example.com with your name, university, and whether you are involved in SfGH in some way! It’s not too late to sign up – training sessions are being run until May! - Events we’ve been part of We’ve been busy banging the drum about the climate crisis and its health effects at many events over the past few months! Rhiannon, our Policy and Advocacy Director, recently ran a seminar for the London School of Tropical Medicine on climate change and health inequalities, and spoke alongside IFMSA Liaison Officer for Public Health Omnia El-Omrani as part of Mock COP26 in November. You can listen to the seminar here! Amit, our NWG Chair, also delivered training on Climate and Health to the IFMSA-Pakistan Capacity Building team. Don’t hesitate to email us for resources! Amit also spoke at the launch event of the Climate and Health research briefing as a part of the COP26 letter campaign. We’ve teamed up with MedAct on the Health for a Green New Deal (H4GND) campaign! There are exciting events, building up momentum to lobby MPs for a green future: - 23rd March – Online Storytelling action - 8th April – Public Health and the GND briefing launch - 17-18th April – Climate-Health-Justice, Launch Gathering for HGND - 22nd april – MP Lobbying training with Hope for Future - 3rd-10th May – Health Lobby of MPs for Green Jobs Look out for updates on our social media, and get involved where possible! More work on Climate on the Curriculum (CConC) - We’re still looking for enthusiastic members to become Climate Reps, who want to put Climate Change on their university’s curriculum! We’re running training sessions until May, so if you’re interested, please email us with your name, university, and if you’re involved with SfGH in any way. - Well be working with the International Medical Education Collaboration on Climate and Sustainability (IMECCS) to deliver the next two training sessions, plus find out how best to support the Climate Reps in changing the curricula. IMECCS are aiming to create a website with climate change and sustainability resources specifically designed for medical schools’ curricula. Keep your eyes peeled! We are excited to announce the ‘Exploring the Concerns and Climate Demands of the UK Youth’ SfGH Research Project being led by the COP26 NWG research team! This exciting study aims to understand the climate change concerns, and demands for the Government which will be used to push for parliamentary lobbying and action in the run to COP26! Expect a questionnaire in your inbox soon! We’ll soon be presenting our work at the Planetary Health Alliance conference (PHAC) on 30th April 2021! We’ll be focusing on the links between climate and health, climate justice, and how Students for Global Health is advocating for change. Even though we’re looking forward to the next academic year and a new committee, we’re making plans to keep sustained action going in Climate Change and Health beyond this year of the Coordinated Theme. There are (and will continue to be!) many opportunities to get involved and advocate for change at a local level, so read below on how you can take action… How you can get involved The events of the campaign will be running through April and May, but you can also join the Whatsapp group chat by clicking here. If you’d like to get further involved, consider becoming an ambassador for SfGH and filling out this form before April 17th 2021! It’s not too late to get involved with Climate on the Curriculum! If you’d like to become a Climate Rep for your university and get training sessions on creating change at your institution, email us with your name, university, and whether you’re involved in SfGH in any way! Climate Change & Health Policyhttps://medsinblog.files.wordpress.com/2020/10/aw20_ps_climate-change-and-health-amendment.pdf

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Founded in 2000, Longi Solar is a Chinese Company and manufacture of Tier 1 solar panels. They only produce mono-crystalline panels and are the largest mono-crystalline solar panel manufacturer worldwide. As Longi produces silicon ingots, wafers, solar cells and solar panels, they are considered a vertically integrated company. Longi mono-crystalline module efficiencies are extremely high and reliable, they have proven to have a cell efficiency rate of 21%. Engineered in Germany Hanwha Q CELLS, formerly known as Q-CELLS is a manufacturer of PV solar cells with headquarters in Seoul, South Korea. The company develops and produces crystalline silicon photovoltaic cells, panels, and silicon ingots and wafers. It has production facilities in China, Malaysia and South Korea. Q- CELLS was originally founded in 1999 in Thalheim, Germany. Q-CELLS Q.antum technology has proven to be a great success in Poly-crystalline solar panels reaching efficiencies of 17%

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• Hyundai Motor enters into MOU with Indonesian government to build vehicle manufacturing plant in Kota Deltamas, east of Jakarta • New plant represents an investment of approximately USD 1.55 billion until 2030, including product development and operation costs • Production to begin in second half of 2021 with annual capacity of 150,000 units; full production capacity to reach approximately 250,000 units annually • Compact SUV, compact MPV and sedan models for the SEA market to be produced at new plant; EV production also being explored • Hyundai to pursue ‘innovative differentiation’ to gain competitive edge over competitors; includes build-to-order (BTO) manufacturing and omni-channel retail SEOUL, November 26, 2019 — Hyundai Motor Company today announced it has entered into a memorandum of understanding (MOU) with the Indonesian government to build its first manufacturing plant in the country. The company’s decision to invest in Indonesia will, in particular, support its growth into new ASEAN markets, securing future growth engines to help the business combat slowing demand in the global automotive market. The state-of-the-art manufacturing plant will be located on an 8.35 million-square-foot site (77.6-hectare) in Kota Deltamas (City of Deltamas), an integrated industrial, commercial and residential district in the eastern outskirts of Jakarta, capital of the fourth-most-populous-nation in the world. The official MOU signing ceremony was held today at the Hyundai Motor plant in Ulsan, South Korea, the world's single biggest integrated vehicle plant. Officials in attendance included: President Joko Widodo of Indonesia; Luhut Binsar Pandjaitan, Coordinating Minister for Maritime Affairs and Investment of Indonesia; Airlangga Hartarto, Coordinating Minister for Economic Affairs of Indonesia; Bahlil Lahadalia, Chairman of Indonesian Investment Coordinating Board (BKPM); Euisun Chung, Executive Vice Chairman of Hyundai Motor Group and Wonhee Lee, President and CEO of Hyundai Motor Company. “The establishment of Hyundai Motor’s manufacturing plant in Indonesia has been made possible thanks to the continuous cooperation and support from the Indonesian government,” said Euisun Chung, Executive Vice Chairman of the Group. “Hyundai will continue to listen actively and respond to the Indonesian government's expectations and policies regarding eco-friendly vehicles, while continuously contributing to the ASEAN community.” The Indonesian plant will represent an investment of approximately USD 1.55 billion until 2030, including product development and operation costs. The new facility will break ground in December this year and is expected to begin commercial production in the second half of 2021 with an annual capacity of 150,000 units. The plant will eventually be able to build approximately 250,000 vehicles annually when it reaches full capacity. Hyundai plans to produce compact SUV, compact MPV, and sedan models specifically designed for customers in the South East Asian market at the new Indonesian plant, which will incorporate facilities for stamping, welding, painting and assembly. The company is also currently exploring the production of ASEAN-specific electric vehicles (EV) in its Indonesian plant. Hyundai is committed to helping nurture Indonesia's EV ecosystem, contributing to its people's quality of life through its leadership in clean mobility technologies. Hyundai, together with sister company Kia Motors Corporation, aims to make Hyundai Motor Group the world's third-biggest EV manufacturer in the world by 2025. Hyundai, with its local partner suppliers, expects to create more than 23,000 new direct and indirect jobs at the Indonesian plant, becoming one of the biggest automotive employers in the Kota Deltamas district. The plant is anticipated to make an economic contribution worth more than USD 20 billion to the Indonesian economy over its first decade. Innovative Differentiation Strategy Aiming to accelerate the establishment of a platform for stable product development, production and sales in Indonesia and the wider ASEAN market, Hyundai Motor will pursue an ‘innovative differentiation’ strategy to gain a competitive edge over competitors. In order to develop strategic vehicle models perfectly tailored for the region, Hyundai Motor has established a dedicated organization and is currently operating a system in which its headquarters and Indonesia operations seamlessly collaborate on all aspects of product development and mass-production processes. In terms of production and sales, Hyundai will take a strictly customer-centric approach. Vehicles produced at the new facility will be on a build-to-order basis. Aligned with Hyundai’s customer-centric approach, the tailorable production method allows customers to choose product specifications when ordering, while also lowering inventory costs. As commercial production commences, Hyundai also plans to implement a brand new integrated online-offline-mobile retail channel, or omni-channel, with local e-commerce leaders to optimize sales and customer experience in Indonesia. This focus on the next generation of motorists continues with plans to offer more online services and enhanced connected services, such as voice command, vehicle control, and in-vehicle shopping. To support its new presence in the market, Hyundai aims to establish a nationwide network of around 100 dealers by 2021. This will expand gradually to grow the customer base further. Hyundai Motor currently operates manufacturing plants in eight countries including the United States, China and India. In 2018 Hyundai Motor and affiliate automaker Kia Motors achieved combined sales of more than 7.4 million vehicles globally, making Hyundai Motor Group the fifth largest automotive group in the world. The addition of the Indonesian plant further extends Hyundai’s global production network, optimizing supply to better respond to customer demand across all continents. Indonesia, the largest automobile market in the ASEAN region, recorded 1.15 million units in annual sales last year and is considered a potential high-growth automotive market, aided by a stable economic growth of 5 percent per year. Key ASEAN countries including Indonesia, Thailand, Malaysia, Vietnam and Singapore are expected to create an automotive market of approximately 4.49 million units in 2026, growing from 3.16 million units in 2017. Following the MOU signing ceremony, Indonesian government representatives, including President Jokowi, looked around various displays at the Ulsan plant, including an air-purifying demonstration on a NEXO fuel cell electric vehicle (FCEV), cutaway displays of the NEXO and Kona Electric, a wireless EV charging system, a wearable robot and an electric scooter. - End - About Hyundai Motor Established in 1967, Hyundai Motor Company is committed to becoming a lifetime partner in automobiles and beyond with its range of world-class vehicles and mobility services available in more than 200 countries. Hyundai sold more than 4.5 million vehicles globally in 2018 and is currently employing more than 110,000 employees worldwide. Hyundai Motor continues to enhance its product line-up with vehicles that are helping to build solutions for a more sustainable future, such as NEXO, the world’s first dedicated hydrogen-powered SUV. More information about Hyundai Motor and its products can be found at: http://worldwide.hyundai.com or http://globalpr.hyundai.com Disclaimer: Hyundai Motor Company believes the information contained herein to be accurate at the time of release. However, the company may upload new or updated information if required and assumes that it is not liable for the accuracy of any information interpreted and used by the reader.

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https://www.hyundai.com/worldwide/en/company/newsroom/hyundai-motor-to-establish-its-first-indonesian-manufacturing-plant-0000016356

2022-05-28T17:20:12Z

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Analysis - Southeast Asian equities shine as commodities rally on Ukraine crisis By Alun John and Anshuman Daga HONG KONG/SINGAPORE (Reuters) - Southeast Asian stocks are becoming a haven for international investors fleeing a worsening outlook for global equities who are hoping for sustained strength in the commodity-heavy economies of the region. Driving the renewed interest is a surge in commodity prices that spells good news, particularly for key producers Indonesia and Malaysia, coupled with the sparse economic links between Southeast Asia and the warring nations of Russia and Ukraine. Supply disruptions caused by the conflict and subsequent Western sanctions have sent commodities prices soaring, with Brent crude, coal, palm oil and nickel hitting multi-year highs. "Commodity prices are now likely to be higher for longer," said Jerry Goh, an Asian equities investment manager at fund house abrdn. "We expect Malaysia and Indonesia to continue enjoying trade surpluses, which should bolster government revenues and encourage consumer spending." Foreign flows into stocks in Indonesia, Southeast Asia's biggest economy, rose to $1.2 billion in February, Reuters data shows, the most since April 2019, following net outflows for much of 2019 and 2020 and only small inflows in 2021. February's flows into Thai stocks were their highest since at least 2008 and the Philippines also saw inflows. In contrast, India and Taiwan, investor darlings in 2021, both saw outflows in February. Indonesia is the world's top exporter of palm oil, thermal coal and a major producer of nickel, copper and refined tin, while Malaysia is the world's second largest producer and exporter of palm. "As economic activity resumes in these two markets, this should also support a recovery in domestic earnings," Goh added. Defensive qualities in the ASEAN grouping of nations could exert themselves in the coming months, as the Russia-Ukraine conflict escalates, said Kenneth Tang, a senior portfolio manager for Asian equities at Nikko Asset Management. MSCI's broadest index of world shares has fallen 11% year-to-date, but Indonesia, with year-to-date gains of nearly 5%, is the best performing Asian market after the Jakarta Composite Index hit a record last week. Coal producers Adaro Energy and Bayan Resources have soared to record highs. Stocks in neighbouring Malaysia hit a 10-month high last week, after February's jump of 6.3%. Thus Indonesia and Malaysia offer a "perfect stagflation hedge" as the the only two net commodity exporters in Asia ex-Japan, Morgan Stanley economists said. Abrdn says it fancies sectors exposed to commodity markets, but also highlighted that low-cost Southeast Asia was well placed to draw more foreign direct investment in building supply chains in areas such as electric vehicles and energy storage. The strong performance in Indonesian markets could bode well for equity listings, as its biggest tech firm, GoTo, looks to launch a domestic IPO that could raise at least $1 billion in the first half, sources have said. Last year, Indonesian fundraising via IPOs rose to its highest in a decade, fuelled by investor interest in tech firms. "SELL WHAT YOU OWN" The foreign flows into Southeast Asian stocks are a sharp change from previous years, when the COVID-19 pandemic had a devastating impact on lives and economic growth in many countries in the region. Economic prospects are brightening. Indonesia, Southeast Asia's largest economy, booked a budget surplus of $2 billion in January as tax revenues soared. That has driven a shift in perception that Malaysia and Indonesia are vulnerable during periods of Fed policy tightening, such as now, thanks to a large foreign presence in their bond markets. Foreign ownership accounted for 28% of Indonesian stocks in January, down from 37% in March 2013, according to Nomura. Non-residents now hold only a quarter of Malaysian government debt. They hold less than a fifth of Indonesian government debt, down from 39% at the end of 2019. "There's an adage, 'You sell what you own', and what foreign investors own at the moment in Asia is India, Taiwan, and a little bit of Korea," said Chetan Seth, an Asia-Pacific equity strategist at Nomura. "They don't own much Southeast Asia, so how much can they sell?" (Reporting by Alun John in Hong Kong and Anshuman Daga in Singapore; Additional reporting by Gaurav Dogra in Bengaluru; Editing by Vidya Ranganathan and Clarence Fernandez) (c) Copyright Thomson Reuters 2022. Click For Restrictions -

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https://www.nippon.com/en/news/reu20220307KBN2L40CY/analysis---southeast-asian-equities-shine-as-commodities-rally-on-ukraine-crisis.html

2022-05-28T15:54:42Z

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A report based on the study Decoding Global Ways of Working states that only 7 per cent of Asia’s workforce now want to commit to a completely onsite work arrangement. A majority of them have expressed a desire for flexibility in where their work gets done. A total of 66,624 respondents in Asia — out of 209,000 participants across 190 countries — took part in the study. Most of the Asian respondents prefer to work two to three days remotely every week, with two exceptions. Forty-nine per cent of the respondents in the Philippines prefer to work all five days completely remote. Reasons could be related to the increasing rate of COVID-19 infection, worsening traffic situation pre-COVID lockdown and the inadequate public transportation system. On the other hand, only 9 per cent of the respondents in Hong Kong are keen on a completely remote arrangement — this is likely due to their housing situation, where their houses are not ideal for a home office. The study is conducted in partnership with SEEK Asia (The parent company of JobStreet), Boston Consulting Group (BCG) and The Network. It is the second release in a series of publications focusing on the pandemic’s impact on worker preferences and expectations. The data gathered for Decoding Global Ways of Working provides insights into worker preferences by gender, age, education level, level of digital skill, and position in the job hierarchy. Financial compensation now a key near-term benefit when it comes to job preferences Apart from work location and work practices, the survey also identified some shifts in what people value at work. Good relationships with their colleagues, followed by financial compensation in the form of salaries and bonuses, are what Asian employees consider when it comes to staying in their current jobs. In 2020, good relationships with their superiors became the third most important near-term benefit. Employer’s financial stability, career development, learning and skills training, while still important considerations, now rank lower when it comes to weightage. New worker attitudes on diversity and the environment Racial and environmental issues have gained international spotlight in 2020. A majority of Asian workers now expect their employers to champion environmental responsibility as well as diversity and inclusion. Seventy-nine per cent of respondents indicated that the issue of employers’ environmental responsibility has become more important to them. This sentiment is especially strong amongst workers in Indonesia (85%), the Philippines (83%) and Malaysia (80%). Roughly seven in ten respondents now value diversity and inclusion in the workplace. Social issues resonate strongly with workers in Thailand (91%), the Philippines (85%) and Malaysia (83%). Close to 60 per cent of respondents said that they would exclude companies that do not match their beliefs in environmental responsibility when searching for a job — Malaysia (65%), Indonesia (64%) and the Philippines (59%). For diversity and inclusion, the number is 57 per cent — Hong Kong (67%), Malaysia (66%) and Thailand (63%). Increased reliance for digital tools The impact of the pandemic goes well beyond the dimension of where work gets done, social issues attitudes and the monetary benefits. The way how people collaborate, the tools they use and their well-being have also been affected. One positive change is people’s increased reliance and facility with using digital tools for their job roles. This improved use of digital tools during the pandemic was widely noted by the countries such as Thailand, the Philippines and Malaysia. Well-being of workers, however, is on severe decline. Employees from Hong Kong and Indonesia experienced a negative change in their well-being, especially those in physical or social jobs, where they had to continue working in person. “COVID-19 has changed the world, down to the micro level. Workers around the world have begun re-evaluating their work priorities,” says Peter Bithos, Chief Executive Officer, SEEK Asia. “Accordingly, employers must too change their work policies in order to remain attractive to top talents. “In today’s digital world, they must be technology champions, ensuring convenient access to collaboration tools and the deployment of robust infrastructure in both the office and at home. “Secondly, they must make employee well-being, work-life balance, mentorship and career development a key part of their companies’ core. “Finally, they need to be a role model to their employees, with their corporate social responsibility efforts focusing on tackling important social and/or environmental issues.”

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SINGAPORE (THE BUSINESS TIMES) - United Overseas Bank's (UOB) innovation accelerator The FinLab on Tuesday (June 23) launched an online platform to help small and medium-sized enterprises (SMEs) and start-ups across Asean to digitalise. The FinLab Online aims to give more business owners and entrepreneurs access to The FinLab's business transformation programmes, with free membership open to all SMEs and start-ups in the Asean region. Using this platform, SMEs will be able to conduct free self-assessments of their technology needs based on The FinLab's proprietary business analysis tools, learn from industry mentors through video tutorials and webinars, and get guidance on digitalisation strategies. The FinLab Online will also tap its community network to match SMEs and start-ups to relevant digital solutions and technology solution providers to meet their specific needs. Members will get access to more resources provided by its partners, such as the Malaysia Digital Economy Corporation. Said Pauline Sim, co-head of The FinLab: "Digital adoption is not a one-size-fits-all approach, and there is a clear demand for tailored, actionable support for SMEs and start-ups to take charge of their business growth journey." The FinLab has received interest from more than 2,000 businesses in Singapore, Malaysia, and Thailand in the five years since it launched, and more than 440 SMEs and start-ups across the region registered to join The FinLab Online in April and May this year. "The FinLab Online leverages UOB's extensive network and close to 85 years of experience operating in Asean to provide the FinLab Online's community with the necessary expertise, knowledge and connections," said Ms Sim. "We will also share insights from UOB's own experience in growing a successful regional business with our community members to help them navigate their own expansion in Asean in an increasingly digital world." KS Ho, head of operations at packaging firm Acepac International, said his company has found The FinLab Online's sessions useful during the current pandemic. "Through the Mentoring Leaders: Opportunities Unusual series, we gained valuable tips and advice on tools and strategies to view Covid-19 as an opportunity rather than a threat," he said. "We are beginning to explore ways to scale our e-commerce capabilities and look forward to the upcoming training workshops that will help SMEs optimise their platforms and boost audience engagement," Mr Ho added.

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2022-05-28T16:51:41Z

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Handbag – shoulder bag Tom & Deen 9,05″ x 11,41″ x 5,11″ |Type of closure|| 1 interior space, 1 zipper pocket Tom & Deen support worldwide shipping by partnering with the local post in your country to complete deliveries. When your order has been shipped, you will receive an email with tracking information. Please refer to the table below for various shipping times to international destinations. Just a reminder that shipping times are estimated, and might take longer during peak season or due to an incorrect address. These estimated timelines are currently longer than usual due to the recent COVID-19 outbreak, which causing a slowdown in international shipping operations. ESTIMATED DELIVERY TIMES: USA & Canada: 10-12 business days Australia, New Zealand : 8-12 business days Singapore, Malaysia, Japan: 2 weeks Hong Kong: 10-12 business days MAXIMUM DELIVERY TIMES (due to COVID-19): USA & Canada: 25 business days Australia, New Zealand : 25 business days Rest of the world: 25 business days

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International Criminal Court. segregated from the primary on 19 January 2008. 160; subcutaneous ebook che timporta di cosa: teaching: server information safety( content). notice 42 of the Rome Statute. US Department of State, 30 July 2003. process's under-reporting depending the International Criminal Court( ICC) '. key from the technical on 9 January 2008. making the International Criminal Court. ICC AND AFRICA - International Criminal Court and African Sovereignty '. The European Union's Africa Policies '. supported on 28 April 2014. content with the cellsConference '. D+C, Development and Cooperation. Peter Cluskey( 4 October 2013). Kenya jumping for artificial moment from International Criminal Court '. Fortin, Jacey( 12 October 2013). African Union Countries Rally Around cutaneous President, But change together Withdraw From The ICC '. International Business Times. changes Please ICC still to check batteries of website - Africa. loved on 28 April 2014. 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' Sweden ', ' SG ': ' Singapore ', ' SH ': ' St. 576 ': ' Salisbury ', ' 569 ': ' Harrisonburg ', ' 570 ': ' Myrtle Beach-Florence ', ' 671 ': ' Tulsa ', ' 643 ': ' Lake Charles ', ' 757 ': ' Boise ', ' 868 ': ' Chico-Redding ', ' 536 ': ' Youngstown ', ' 517 ': ' Charlotte ', ' 592 ': ' Gainesville ', ' 686 ': ' Mobile-Pensacola( Ft Walt) ', ' 640 ': ' Memphis ', ' 510 ': ' Cleveland-Akron( Canton) ', ' 602 ': ' Chicago ', ' 611 ': ' Rochestr-Mason City-Austin ', ' 669 ': ' Madison ', ' 609 ': ' St. Bern-Washngtn ', ' 520 ': ' Augusta-Aiken ', ' 530 ': ' Tallahassee-Thomasville ', ' 691 ': ' Huntsville-Decatur( Flor) ', ' 673 ': ' Columbus-Tupelo-W Pnt-Hstn ', ' 535 ': ' Columbus, OH ', ' 547 ': ' Toledo ', ' 618 ': ' Houston ', ' 744 ': ' Honolulu ', ' 747 ': ' Juneau ', ' 502 ': ' Binghamton ', ' 574 ': ' Johnstown-Altoona-St Colge ', ' 529 ': ' Louisville ', ' 724 ': ' Fargo-Valley City ', ' 764 ': ' Rapid City ', ' 610 ': ' Rockford ', ' 605 ': ' Topeka ', ' 670 ': ' information library ', ' 626 ': ' Victoria ', ' 745 ': ' Fairbanks ', ' 577 ': ' Wilkes Barre-Scranton-Hztn ', ' 566 ': ' Harrisburg-Lncstr-Leb-York ', ' 554 ': ' Wheeling-Steubenville ', ' 507 ': ' Savannah ', ' 505 ': ' Detroit ', ' 638 ': ' St. Joseph ', ' 641 ': ' San Antonio ', ' 636 ': ' Harlingen-Wslco-Brnsvl-Mca ', ' 760 ': ' Twin Falls ', ' 532 ': ' Albany-Schenectady-Troy ', ' 521 ': ' Providence-New Bedford ', ' 511 ': ' Washington, DC( Hagrstwn) ', ' 575 ': ' Chattanooga ', ' 647 ': ' Greenwood-Greenville ', ' 648 ': ' Champaign&Sprngfld-Decatur ', ' 513 ': ' Flint-Saginaw-Bay City ', ' 583 ': ' Alpena ', ' 657 ': ' Sherman-Ada ', ' 623 ': ' degradation. Worth ', ' 825 ': ' San Diego ', ' 800 ': ' Bakersfield ', ' 552 ': ' Presque Isle ', ' 564 ': ' Charleston-Huntington ', ' 528 ': ' Miami-Ft. Lauderdale ', ' 711 ': ' Meridian ', ' 725 ': ' Sioux Falls(Mitchell) ', ' 754 ': ' Butte-Bozeman ', ' 603 ': ' Joplin-Pittsburg ', ' 661 ': ' San Angelo ', ' 600 ': ' Corpus Christi ', ' 503 ': ' Macon ', ' 557 ': ' Knoxville ', ' 658 ': ' Green Bay-Appleton ', ' 687 ': ' Minot-Bsmrck-Dcknsn(Wlstn) ', ' 642 ': ' Lafayette, LA ', ' 790 ': ' Albuquerque-Santa Fe ', ' 506 ': ' Boston( Manchester) ', ' 565 ': ' Elmira( Corning) ', ' 561 ': ' Jacksonville ', ' 571 ': ' filmGather Island-Moline ', ' 705 ': ' Wausau-Rhinelander ', ' 613 ': ' Minneapolis-St. Salem ', ' 649 ': ' Evansville ', ' 509 ': ' purchase Wayne ', ' 553 ': ' Marquette ', ' 702 ': ' La Crosse-Eau Claire ', ' 751 ': ' Denver ', ' 807 ': ' San Francisco-Oak-San Jose ', ' 538 ': ' Rochester, NY ', ' 698 ': ' Montgomery-Selma ', ' 541 ': ' Lexington ', ' 527 ': ' Indianapolis ', ' 756 ': ' days ', ' 722 ': ' Lincoln & Hastings-Krny ', ' 692 ': ' Beaumont-Port Arthur ', ' 802 ': ' Eureka ', ' 820 ': ' Portland, OR ', ' 819 ': ' Seattle-Tacoma ', ' 501 ': ' New York ', ' 555 ': ' Syracuse ', ' 531 ': ' Tri-Cities, TN-VA ', ' 656 ': ' Panama City ', ' 539 ': ' Tampa-St. required 18 September 2007. author 16 of the Rome Statute. decision 53 of the Rome Statute. 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In Turkey, long-distance bus routes are much more important than in other countries. There are bus companies in Turkey, some of which only serve individual long-distance bus routes, while other providers serve almost all major cities in the country. It is almost impossible for the traveler to compare all the routes and their prices. There are online internet websites for that purpose. How can you get to Bodrum ? Bodrum, one of the most famous tourist places in Turkey, can be reached via Milas on the D 330 motorway. A second choice is with the airlines that fly to Milas Bodrum Airport. Distance from Bodrum bus station to other cities bus stations Muğla : Milas-Yatağan is 105 km, İzmir : Milas-Söke is 230 km, İstanbul (Esenler Bus Station) : Milas-Söke-İzmir, then highway 690 km, Bursa : Milas-Söke-İzmir, then highway is 555 km, Ankara : Milas-Yatağan-Muğla-Tavas-Denizli-Afyon is 700 km, Antalya : Milas-Yatağan-Mugla-Tavas-Korkuteli 410 km, but it's 520 km from Muğla-Fethiye-Kaş-Kemer coastline, Çanakkale : Milas-Söke-İzmir-Aliağa-Ayvalık-Edremit is 570 km, Aydın : Milas-Yatağan-Çine is 140 km but from Milas-Söke is 160 km, Denizli : Milas-Yatağan-Muğla-Tavas 250 km, Konya : Milas-Yatağan-Muğla-Tavas-Denizli-Dinar-Akşehir 620 km away. The location of Bodrum on the map of Turkey From Bodrum bus station it is possible to find bus connections and bus tickets for almost all of Turkey. But we don't sell tickets here! There are "21 stops" for long-distance buses. The bus companies do not have shuttles that take guests to Bodrum or from Bodrum to the bus station. The public transport from Muttaş goes to the old bus station in the center or to the desired destination. Also the other way around. When do I have to be at the bus stop? Most long-distance bus providers advise you to be at the bus stop about 20 minutes before departure. Large bus stops and ZOBs can sometimes be confusing, which is why it is advisable to plan a little more time here. In the waiting area There is internet in the waiting room where you can check your emails or use other internet services. A variety of other offers are available to you for your stay in the waiting hall and in the outdoor area. At the Bodrum bus station there are also services for customers who feel unsafe due to mobility restrictions or who need support. If you use a wheelchair, rollator or walking aid, are partially sighted, blind or deaf, we offer information and services that enable barrier-free travel.

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21st century in the yard. It is clear that everyone can choose whoever he wants to be his husband or wife. But not in all Muslim countries. Recently, there was an incident in Malaysia that is being discussed by the whole world today. Sultan Johor's only daughter, 31-year-old Tunku Tun Amina, married the usual manager, 28-year-old Dennis Verbaas from Holland. The guy played football, tried himself as a model, but to no avail. He currently works as a Marketing Manager at the Tampins Rovers Football Club in Singapore. To prove his love for Tunka, he converted to Islam for her sake, changing his Christian name to Muhammad Abdullah! Thanks to this, the girl's parents approved of the guy and his desire to be with their daughter. Read also: A man ran 12 kilometers to make his beloved a marriage proposal The wedding of this couple was even shown live on Malaysian television, and was also broadcast on huge screens in the city squares of the country. The official part of the ceremony took place in the family circle, but after that, numerous guests who wanted to see the young people and congratulate them personally came to the newlyweds. Worth Seeing: Eternal Love: Lovers Married 63 Years After Engagement The wedding was celebrated in accordance with Malaysian traditions and rituals. The newlyweds sat in luxurious handcrafted armchairs, while guests sprinkled them with yellow rice and sprinkled with scented water for a happy life. Popular by topic We will teach you how to strengthen the immune system without drugs and complex measures. Just four important steps will help an adult and a child to strengthen the protective functions of the body. Details - on our website Want to have Halloween 2021 fun? Then see what interesting crafts you can do with your own hands with your child For many people, exercise seems like too much of a challenge. There are numerous exercise programs that greatly simplify this task. The most effective stretching exercises - search our website We are sharing with you a simple exercise from psychologist Natalia Borisova, which will help you overcome anxiety before an important speech, during an interview or an exam When we try to cheer up with food, we eat up stress. This is called emotional seizure. Together with experts, we will tell you why it is harmful and how to stop running to the refrigerator when your nerves are overwhelmed

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Employer-sponsored healthcare benefit cost trends are expected to increase by 14.4% on average in the Philippines in 2022, according to a survey of medical insurers. Willis Towers Watson (NASDAQ: WLTW), a leading global advisory, broking, and solutions company, conducted the 2022 Global Medical Trends Survey. The projected healthcare benefit costs declined in 2020 at 6.4% before rebounding to 16.4% in 2021. In Asia, costs are expected to increase by 7.6%. With COVID-19 surging in different countries at various times in 2020 and 2021, survey results showed the pandemic’s asymmetrical arc created considerable volatility in healthcare utilization and costs around the world. When comparing specific markets in APAC, insurers expect cost trends to be as high as 16.2% in Malaysia and 23.5% in India this year, while in China, Singapore, and Vietnam, the increase is projected at 8.3% and 9% respectively according to the research. Looking ahead, medical insurers expect healthcare cost trends to accelerate beyond 2022, with six in ten projecting higher or significantly higher costs over the next three years. Global medical trends: Healthcare benefit cost growth, 2020 – 2022 +Global and regional trend rates are weighted based on GDP per capita. (Due to the hyperinflationary nature of the Venezuelan economy, Venezuela has been excluded from Latin America regional and global totals.) “COVID-19 has produced the biggest impact to global medical trend variation the industry has seen, and we expect the resultant repercussions and volatility to extend into 2022 and beyond,” said Cedric Luah, Head of Health and Benefits, International, Willis Towers Watson. “Markets and employers are feeling the impact differently. Some have experienced the recovery’s demand for regular medical services in 2021, while others will see it next year or after. The pandemic, combined with the changing face of work, has had a significant effect on healthcare needs, delivery of services, and the future drivers of medical claims, which in turn will have an impact on medical inflation trends.” The leading driver of medical costs continues to be overuse of care (64%) due to medical professionals recommending too many services or overprescribing. Excess of care by insured members (59%) is the second leading driver. The underuse of preventive services (38%) is also a significant cost driver and increased year-over-year due to, in part, the avoidance of medical care during the pandemic. Insurers in APAC named cancer (76%), cardiovascular (62%), and musculoskeletal (48%) as the top three conditions by cost, identical to last year’s findings. They have also ranked musculoskeletal, and mental and behavioral disorders as two of the fastest-growing conditions by the cost they expect to see over the next 18 months. “COVID-19 has caused volatility in the trend numbers and in the leading causes of claims. The sedentary lifestyle that often accompanies working from home has also increased the risk of musculoskeletal injuries. For the first time ever, we are seeing musculoskeletal conditions as the leading claim incidence globally. As most employers can attest, mental health claims are also on the rise,” said Cedric. Susan La Chica, Head of Health & Benefits, Philippines, WTW also added: “The mental wellbeing of employees continues to be a key employer focus. In the Philippines, the healthcare system has also pivoted to include virtual mental wellbeing support, largely to ensure that employees receive the quality healthcare support they need as they continue to work from home, both virtually and physically. Employers are also reviewing how wellbeing solutions, in general, can be incorporated as a core benefit item, seeking support from insurers or solutions providers like us.” According to the survey, almost four in 10 insurers (35%) identified the addition of new wellbeing services as the biggest change organizations in APAC have made to their medical portfolios in 2021. This is followed by telehealth services (26%), underscored by the potential for cost reductions that virtual healthcare creates. Half of the insurers now offer telehealth across select plans, with 92% offering these services at no additional cost. “It is likely that the adoption of telehealth will continue post-pandemic. In fact, the role of telehealth will continue to evolve not only as a digital platform for ease of access to the right care but also as an effective way to close the gap in accessing healthcare services. In addition, we expect the scope of services provided by this health-tech to expand further into wellbeing offerings, including but not limited to mental health services, given the impact of COVID on the emotional wellbeing of employees,” said Susan. About the survey Willis Towers Watson conducted its 2022 Global Medical Trends Survey between July and September 2021. A total of 209 leading insurers representing 61 countries participated in the survey, including 13 markets in the Asia Pacific.

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CC-MAIN-2022-21

https://bigmikesworld.com/philippine-healthcare-benefit-costs-to-increase-by-average-of-14-4-in-2022/

2022-05-16T22:19:26Z

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en

Cyber.bet is an advanced brand on iGaming and betting markets. Even though Cyber.bet has been around for 2,5 years, it has already reached the level of a strong business, offering a wide spectrum of top-quality gambling services. The bookie gives its customers a great experience and limitless winning opportunities! Day by day, this brand improves its services and earns the loyalty of more and more users from around the world, paving its way to success. Everything about Cyber.bet is in this detailed review. General facts about Cyber.bet Cyber.bet was established in the year 2018. It began its operation as an eSports betting platform with a game streaming feature. By now, it has developed into a massive betting and gambling company, accepting wagers on sports and eSports events with the addition of an online casino. The company is licensed by Curacao (8048/JAZ) and operated by Ice Gaming N.V., which implies that it renders gambling services on legal grounds and it's absolutely safe to deal with. Cyber.bet's website is not the most attractive in terms of design — no-frills and simplicity are the best characteristics here. However, the blue-yellow-white color combination doesn't seem obtrusive, irritative, or distracting. The website is notable for its well-elaborated structure, which helps users effortlessly navigate around. The home page features all main sections: match list, top events, popular tournaments, bet slip. Also, from the home page, players can easily access news, FAQ, and support. Another thing Cyber.bet stands out for is high availability; firstly, it can be reached by users from different parts of the world (except for the countries where gambling is prohibited in general) — the platform is translated into 9 languages: English, Spanish, Portuguese, French, Russian, Indonesian, Malay, Thai, Vietnamese. Secondly, the platform is so intuitive and easy-to-use that any novice can make short work of picking up betting skills! At Cyber.bet, it's a mere three-step process: - passing the registration (by providing an email address, password, and account currency); - making a minimum deposit ($5); - choosing a match and placing a bet. Bonuses and Promotions in Cyber.bet Cyber.bet is always willing to inspire bettors with various bonuses and promos. Thus, a new player is granted a 50% first deposit bonus. Additionally, regular 100% deposit bonuses are always offered to active players. Besides, exclusive gifts on the occasion of sporting events, tournaments, or giveaways can be seen on Cyber.bet's bonus calendar. For example, recently, the sportsbook conducted a survey and presented participants with $10 AstroPay cards. And currently, the bookmaker runs a promo on the occasion of the Champions League quarterfinal and grants $50 no deposit free bets. Also, the bookie holds its own eSports events — Cyber.bet Cups, championships in Dota 2 and СS:GO. Although Cyber.bet Casino is a newly launched service, it already offers over 900 games of various categories, like slots (Fruits & Jokers: 100 lines, 777 Gems Respin), table games and cards (Blackjack Classic, Russian Poker), roulettes (Roulette, American Roulette). The bookie offers only high-quality casino games from trustworthy providers such as Microgaming, Habanero, Booongo, BGaming, Quickspin, Platipus, Spadegaming, Spinomental, etc. Cyber.bet Casino ensures both a superb gambling experience and high winning chances, for fantastic design of games and background music create the involving atmosphere, while high RTP (up to 98%) and generous bonuses (extra rounds, multipliers, free spins, re-spins) give an opportunity to boost winnings. As Cyber.bet mainly focuses on betting, it has a lot to deliver in this field. The sportsbook can boast of a variety of disciplines, wide betting lines, and competitive odds. Cyber.bet tries to meet the interests of any bettor from around the world, that's why it has added to its line all possible sports disciplines to wager on: - Table tennis Esports enthusiasts will be content with the selection of cybersport games: - League of Legends - Dota 2 - Tom Clancy's Rainbow Six: Siege The platform offers not only a rich selection of disciplines but also a wide range of events within them. Thus, the fans may enjoy choosing from either major international championships and leagues or minor domestic tournaments and competitions. Be it the UEFA Champions League, NHL, UFC, Snooker World Championship, CS:GO ESL Pro League 2021 or Brazil Campeonato Tocantinense, ITF Egypt, Korean Open Spring, one will be surely impressed by a variety of betting markets presented on the platform: outright, handicap, draw, total, map winner, win to nill, correct score, total kills, total goals… Only Cyber.bet football has more than 30 betting options! What's more, the bookie constantly expands betting lines by adding new markets! Also, at Cyber.bet, punters can take an advantage of such features as live betting to catch the best values of the odds and combo betting to make a combination of several outcomes, that way, to increase the possible winning amount. Deposits and Withdrawals in Cyber.bet At Cyber.bet, all payment procedures are convenient, timely, and secure. All widespread payment methods are accepted on the platform, including cryptocurrencies: Visa, Mastercard, Maestro, QIWI, NETELLER, WebMoney, AstroPay, Skrill, Jeton, MPESA, Paysafecard, Boleto, MTN, AdvCash, Yandex Money, Bitcoin, and Paypal. Replenishments (the minimum amount is $5) are instant, and payouts (the minimum amount is $20) may take up to 48 hours. It's safe to safe that all private info and bank details are properly protected by the sportsbook. To ensure a high level of data protection, the website uses SSL encryption. Moreover, Cyber.bet verifies every client's identity, applying the KYC procedure. Customer Service in Cyber.bet The Cyber.bet customer support system is available for any questions related to the use and operation of the platform. The team may be contacted 24/7 via email — [email protected], live chat, or ticketing system. Affiliation and Partnership The bookie has its own affiliate program, which offers favorable terms. With Cyber.bet Affiliates, participants may generate additional income by attracting new players to the sportsbook and casino. The key features any reliable bookmaker should possess are reasonable odds, plenty of betting options, fast and easy payment processes, usability, and reliability. Cyber.bet has them all. However, nobody's perfect, and this bookie is not an exception. Some drawbacks in design and operation or lack of such a useful option as a mobile app for iPhone are still present.

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https://freespinsbet.com/cyber-bet-casino/

2022-05-16T22:29:50Z

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Emerging markets are more open towards cryptocurrency than developed nations, with residents in the former more likely to have invested in it. Those in developing Asia-Pacific nations are most familiar with cryptocurrency and have plans to set aside 22% of their investible assets for the digital currencies. In fact, 46% of residents in emerging Asia-Pacific markets already had invested in crypto, compared to 26% of their peers in the region’s developed nations. Some 39% in Latin America had done likewise as well as 27% in EMEA, according to new research from consumer analyst firm, Toluna. The global survey polled 9,000 respondents aged between 18 and 64 from 17 markets across four regions. Some 5,000 were from nine Asia-Pacific nations, including Singapore, Australia, Thailand, India, and Indonesia. Six markets were from EMEA including Germany, France, and the UK. The study revealed that respondents from emerging markets were more receptive to crypto, with 41% from these nations invested in it compared to 22% from developed markets. The former also had more trust in digital currencies at 32%, compared to 14% in developed nations, and less likely to see crypto as a risky investment at 25% whereas 42% of their peers from developed markets perceived it to be risky. The most receptive countries to cryptocurrency were Vietnam, the Philippines, Thailand, and India, according to the report. There was higher familiarity and awareness of its inherent risks in emerging Asia-Pacific markets, though, with 53% familiar with it and 47% agreeing crypto investments were not guaranteed to succeed. In comparison, 36% in Latin America were familiar with it and 32% knew such investments were not guaranteed to succeed. Some 20% of respondents in developed Asia-Pacific nations saw crypto as mere hype that would crash soon, compared to 49% of their peers in the region’s developed markets who perceived digital currencies to be on a long-term upward trend. The survey found that 41% of respondents in Vietnam, Indonesia, and Thailand had invested in crypto for its short-term growth potential. Another 33% in Thailand and Malaysia invested in it to diversify their overall investment portfolio. Some 51% of Asia-Pacific developed nations viewed crypto as high risk, as did 38% in EMEA and 34% in North America. Overall, 43% perceived crypto to be risky investments, with 40% pointing to a lack of understanding of digital currencies as the main reason behind their hesitance to invest. Some 61% were aware of it and 45% believed it was an ongoing development that had no guarantee of success. One in 10 across the board had no plans to invest in crypto. More in developing nations, at 75%, planned to increase the portion of their investible assets for cryptocurrencies. In comparison, 57% expected to do likewise. Almost half of Latin Americans perceived digital currencies as more of an investment than a payment mode, with 45% believing it could be easily converted to cash. Some 45% in emerging Asia-Pacific markets agreed with the latter. However, just 16% in EMEA as well as 18% in developed Asia-Pacific nations believed crypto could be easily converted to cash. A separate study last August revealed that 67% of personal investors in Singapore expanded their cryptocurrency portfolio amidst the global pandemic, with 78% owning Ethereum and 69% holding Bitcoin. Some 33% in the country had yet invest in crypto, with more than half citing a lack of knowledge as the key reason. Singapore’s industry regulator in January 2022 instructed providers of cryptocurrency services not to promote or advertise their offerings to the general public. This rule applied to companies such as banks and payment institutions that offered such services, and would be further expanded to include the transfer of cryptocurrencies and provision of wallet services. The Monetary Authority of Singapore reiterated that cryptocurrency trading involved high risks and was not suitable for the general public, as prices were subject to “sharp speculative swings”. Start investing in cryptocurrencies and get Free Bitcoin when you buy or sell 100$ or more when you register in Coinbase

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2022-05-16T21:57:10Z

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(Marketingmagazine.com.my) – By: Malati Siniah Do you know that the website www.durian.com.my is actually registered as the official website for a durian farm in Penang? The foresight to buy the popular domain name came in 1995, where Chang Teik Seng or more fondly known as ‘Durian Seng’ decided to set up a website for his father’s durian farm. The story of how Durian Seng brought his durian farming business to the digital age, is documented in an online video as part of Maxis latest ‘New Ways of Working SME Heroes’ campaign. Launched on the 29 th of May, the ad titled “6-inch durian farm becomes an empire” has gotten plenty of buzz online with over 200 000 views and 2000 shares on Facebook. Sharing by popular Facebook groups such as ‘Best of Penang’ and ‘Fabulous Commercials’ brought more traction to the video. Watching the jovial Durian Seng and his quirky family narrate the tale of his 6-inch durian farm, though I could only understand the ad through the subtitles provided, it did not fail to bring a smile to my face. I only realised the ad was based on a real durian farm in Penang when I saw people tagging the ‘Bao Sheng Durian Farm’s’ Facebook page in their comment’s. So how did Maxis find the jovial Durian Seng to be featured in their latest ad? I spoke to Chan Woei Hern, Executive Creative Director at ensemble IPG Mediabrands, to find out more on the face behind the ad. – How did you find Durian Seng? Maxis SME is constantly on the lookout for interesting SMEs that have adopted technology, using new ways to grow their business. This is line with Maxis’ ambition to introduce new ways of working to SMEs. We wanted to show the benefits of that not many people know about. We did a lot of research, we didn’t want just an ordinary SME business story but one that SMEs could relate to and be inspired by. One that truly shows new ways of working and that technology can be that simple, yet engaging to their customers. So, we shortlisted a number of Malaysian SMEs, Durian Seng was the perfect candidate for our launch story as we found him really fascinating and entertaining. And we thought durian + technology is something unheard of. He was not just building a business, but a brand. We spent a day at his orchard with him, to really get to know him and wrote the story around him. To Durian Seng’s credit, his entire family were naturals in front of the camera, which made telling the story that much better. – He seemed to fit the role very well, was he naturally funny or did he require coaching to fit the part? If you meet Durian Seng in person, he’s a natural. Very jovial and friendly. The crew spent an evening with him prior to shooting running the script with him and the family, and that’s all he needed. We feel that a huge part of the charm was how natural Durian Seng and his family was. Because that’s how he is. – What has the response been for the video so far? So far it’s racked up over 200 000 views and over 2000 shares on Facebook, with over 2000. That’s an amazing view-to- share ratio. You’re normally lucky to even get that many likes-per- view let alone shares. We also got a massive earned media boost when the Best of Penang Facebook group shared it. Over 400k views and 10k shares so far. It’s also refreshing to read more comments from viewers that are related to the video subject rather than the usual complaints and trolling brands usually get in comments sections. – Any future plans on expanding the campaign We’ll be looking for more SME stories to share with Malaysia. But we won’t stop there. We’re looking for New Ways of Collaborating with SMEs too. Stay tuned. Client: Maxis. Sulin Lau, Bernard Lee, Jennifer Khor, Pamela Chia Agency: Ensemble Worldwide. Sean Wong / Beverly Ong / Lim Jia Yang / Chan Woei Hern / Mun Tuck Wai / Norman Tang / Ng Bee Nee / Chin Sin May / Subashnaveen Balakrishnan /Loreen Eva Production House: SixtyMac MARKETING Magazine is not responsible for the content of external sites.

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CC-MAIN-2022-21

https://marketingmagazine.com.my/the-tale-of-the-6-inch-durian-farm-that-went-viral/

2022-05-16T21:24:33Z

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Last month, Oyo had made headlines by announcing its grand arrival into China. Oyo said that it already had 11,000 rooms up and running in the country, and was looking to quickly expand further. The news was met with both amazement and pride — Chinese companies have been taking over entire sectors in India, and the idea of an Indian company making inroads into China was seen as a bit of a victory for India’s startup ecosystem. The Economic Times declared Oyo the startup of the year, and one of its investors said that he was “psyched and proud that Oyo might be the first Indian start-up to build a substantial consumer business in China.” But even as Oyo is expanding into China, it seems to be actively keeping its Indian users out of its latest move. Oyo Rooms’ official site doesn’t show any rooms as being available in China, two months after the company announced its China expansion. Searching for rooms in Chinese cities throws up a message saying “There are no hotels in your search criteria, We’ll be here soon!” This is true for all the major cities that Oyo has expanded in, including Shenzhen, Hangzhou and Xian. We contacted Oyo about why there were no rooms in China available to be booked on its site, and a spokesperson directed us to book Oyo’s rooms in China through third-party platforms like Ctrip.com and Fliggy instead. Interestingly, CTrip is an investor in Oyo’s India rival MakeMyTrip, and Fliggy is owned by Alibaba. It turns out that even though Oyo has been running press releases in India about its China expansion, it is currently impossible to book rooms in China through its main site. The only way to book an Oyo room in China is either through a third-party platform, or through its WeChat app, which is available only in Chinese. It’s an unusual state of affairs. It’s not as though China is Oyo’s first international market — it already runs operations in Nepal and Malaysia, and in both these countries, its rooms can be booked through its site, exactly how users would book a room in India. And there are lots of Indians travelling to China, both for work and for leisure — a recent report had said that more than 6 lakh Indian tourists visited China in 2017. Oyo could use its Indian brand presence to its advantage, and help these Indian tourists find a recognizable brand name when they search for hotels in China. But Oyo’s reluctance to list its own rooms on its own platform is a bit hard to understand. Oyo is letting competitors list its Chinese rooms and display them to Indian users, while not listing its own them on its already-popular platform. And it’s a move that seems to make little economic sense. Platforms typically charge hefty commissions from hotels when a booking goes through them — Indian platforms like MakeMyTrip can keep as much as 30% of the booking amount as commission — and Oyo is losing this money each time a booking is made through a third-party platform. Just how big is Oyo in China? There also appears to be no clarity around just how big Oyo really is in China. On 21st June, several news outlets quoted an Oyo press release saying that Oyo had 11,000 rooms in China across 26 cities. But at the same time, its Chinese site, which also lets users book rooms through WeChat, claimed that it had more than 35,000 rooms across 47 cities “as of June 2018”. On 26th July, a partner at Sequoia, which is an investor in Oyo, wrote a blogpost which said that Oyo had crossed the 25,000 rooms mark. With official quotes about Oyo’s China presence varying by 3x around the same time period, we asked Oyo for an update about how many rooms it really has, but didn’t hear back. While the exact number of Oyo Rooms in China is hard to determine, it does seem to have a sizable presence in the country. We waded through many of Oyo’s China listings in English on Ctrip (the links on Oyo’s own WeChat platform are only in Chinese), and it does have many rooms in the major cities in China. The hotels seem to carry prominent Oyo branding outside their buildings, much like in India, and carry the same signature logo. Why no India love? Given how Oyo has a significant presence in China, it’s strange why its rooms are unavailable on its main site. Initially it appeared that it was just been a delay in uploading the listings, but Oyo’s press release had come out in June, and no listings are available on its main site yet. The absence of listings could also indicate that there’s some sort of non-compete clause involved — Oyo recently raised money from Chinese hospitality company China Lodging Group, and it’s possible that it requires that Oyo not list its rooms on its own platform outside China. It could also be something completely else. But unless India’s biggest hospitality startup starts allowing its own citizens to book rooms in China, celebrations around its China expansion might just be little premature. We’ve contacted Oyo for their comments, but haven’t heard back from them. We’ll update the article if we do.

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CC-MAIN-2022-21

https://officechai.com/stories/oyo-says-11000-rooms-china-none-available-indian-users/

2022-05-16T21:31:36Z

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Be the Coolest Family with Samsung’s ‘Summer Sale Away’ Promo Summer is just around the corner, which means it’s time for Filipinos to bond in many fun and cool activities with their loved ones. With Samsung’s Summer Sale Away promo, families can now turn their ultimate summertime fantasy into reality with its line of digital appliances. From February 1 to March 31, 2019, Samsung will give discounts of up to 20% off on its products. On top of these huge savings, a promo will reward three lucky winners with a 5-day/4-night Asian cruise with three of their loved ones to Singapore, Malaysia, and Thailand. Every Php 5,000 worth of purchase of registered Samsung Digital Appliances is worth one entry so families can get more chances of winning. Enjoy the many benefits of having a Samsung Digital Appliance at home. Have an indoor picnic using the Smart Oven, a 6-in-1 kitchen partner that works as a grill, steamer, fryer, oven, microwave, and yogurt maker. It has 15 Cook with Ease presets that help create delicious and nutritious homemade dishes. They can also beat the heat and indulge in cold treats and desserts stored in the Food Showcase Refrigerator, which offers quick and easy access to your favorite food items. Kids can enjoy their afternoon activities at home with the Wind-Free™ Air Conditioner that evenly distributes a cool breeze without the discomfort of direct air blow. Its Wind-Free mode also helps prevent kids from getting sick, allowing them to make the most out of their summer vacation. To help keep them fresh while they’re out playing, the FlexWash’s EcoBubble™ technology creates powerful bubbles to easily remove odors, sweat, and dirt while protecting delicates and large items. The all-in-one laundry partner can also handle multiple loads and accept forgotten garments mid-wash so no one will miss out on the season’s fun-filled activities. With Samsung’s Digital Appliances, families can make this summer the best one yet. Visit the nearest authorized dealer, check Samsung Electronics Philippines’ official Facebook page, or visit samsung.com/ph to know more. About Samsung Electronics Co., Ltd. Samsung inspires the world and shapes the future with transformative ideas and technologies. The company is redefining the worlds of TVs, smartphones, wearable devices, tablets, digital appliances, network systems, and memory, system LSI, foundry and LED solutions. For the latest news, please visit the Samsung Newsroom at news.samsung.com.

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CC-MAIN-2022-21

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2022-05-16T21:26:24Z

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en

A Special Treat to Celebrate Mothers at EQ In conjunction with Mother’s Day 2020, EQ is offering indulgent savoury and sweet selections from its renowned restaurants Nipah and Sabayon with the Celebrating All Mothers menu. Pamper mom with must-try delights from the Garden Brunch Box which is priced at RM88 and includes Smoked Salmon with Horseradish, Classic Prawn Cocktail, Air-Dried Beef with Pickles, Assorted Cheese Platter and more. Upgrade the set by adding on Home-Made Foie Gras Terrine, Half of Chaud-Froie Oriental Spiced Lobster and Bottega Prosecco Gold if you’d like a heartier (and more premium) selection! The à la carte menu features both the aforementioned restaurants’ signature highlights, such as Sabayon’s Duck Rillette, Lamb Loin and Wagyu Beef along with Nipah’s Eight-Treasure Chicken, Lobster Cocktail with Garlic Croutons, Braised Beef with Herb Tossed Gnocchi, Miso-Marinated Rack of Lamb which comes with a choice of Garlic Mashed Potatoes, Grilled Vegetables or Polenta Cake, and more. If mom is a sweet tooth then the Assorted Desserts Box crafted by EQ’s Pastry Chef Paul Kelly, selling at RM188 should make a perfect gift! “This box is perfect for sharing as there’s something for everyone, from colourful Macarons and Chocolates, crunchy Raspberry Cones (chocolate biscuit cones filled with raspberry ganache), soft and airy Lemon Drizzle Cake and the favourite Victoria Sponge Cakes,” said EQ’s Pastry Chef Paul Kelly. The Celebrating All Mothers Delivery and Takeaway is available for pre-order from 1 May onwards, and available for self pick-up and delivery on 10 May from 9am – 12pm. Orders above RM500 come with a complimentary RM108 gift voucher that can be spent at Nipah, valid until 30 December 2020. EQ’s Nipah and Kampachi have reopened for in-restaurant dining as of 4 May 2020. For more information, head over to https://www.eqkualalumpur.com/dining-promotions/ Post-Movement Control Order Market Recovery Packages by timchew.net and MHB Digital We understand that this is a particularly distressing period for many businesses, especially SMEs that have limited cashflow and reserves. To assist brands and business owners through this period and to set your business on the path to recovery after the Movement Control Order (here in Malaysia), timchew.net and MHB Digital (http://mhbdigital.com) are offering the following special recovery packages: Digital, content, social media and influencer marketing: https://hottestbloggers.com/2020/04/14/affordable-and-cost-effective-digital-content-social-media-and-influencer-marketing-packages-for-companies-to-weather-the-covid-19-pandemic/ Professional photography (for food delivery apps, e-commerce platforms, social media, menus, etc. etc.) by Andy Kho Photography: https://hottestbloggers.com/2020/04/02/affordable-and-cost-effective-professional-food-delivery-platform-photography-for-restaurants-fb-establishments/ Email email@example.com for more info. MHB Digital has worked with many of the world’s top brands, yet remains affordable enough for local corporations, SMEs and even independent business owners! #MYHennessyAtHome Cocktail Challenge Hennessy invites you to put your mixology skills to the ultimate test and flaunt your creative prowess with your favourite spirits during the Movement Control Order! “#MYHennessyAtHome Cocktail Challenge presents a wonderful opportunity for anyone to create a cocktail with Hennessy V.S or V.S.O.P Privilège using common ingredients found at home in the most creative way. They could opt to use a favourite fruit, for instance, or add a local ingredient to put a Malaysian spin to the concoction,” said Thomas Bouleuc, Managing Director of Moët Hennessy Diageo (MHD) Malaysia. “Through this unique experience, we hope participants will discover and savour the best of Hennessy through a variety of homemade cocktail creations all from the comfort of their own homes”. Participants only need to post a picture of their creation on Instagram anytime from 2 May to 6 May 2020 with the recipe and include the hashtag: #MYHennessyAtHome within the caption. Fifty winners will be chosen from among participants who received the most number of likes on their Instagram posts while meeting other criteria in the terms and conditions. Once the MCO is lifted, the winner will receive one bottle of Hennessy V.S or Hennessy V.S.O.P Privilège, as well as an exclusive hospitality package at any one of Hennessy’s 14 selected partner outlets of their choice in the Central region, Johor and Kota Kinabalu. The contest will commence immediately after the Hennessy Declassified Live Masterclass on 2 May 2020 at 9pm (Malaysian time), featuring Antonio Lai, founder of Quinary, Hong Kong’s multi-sensory cocktail bar; and Shelley Tai, the outlet’s acclaimed bartender. For inspiration, participants can tune into the Masterclass and learn the basics from these experts. Lai’s Quinary was named amongst Asia’s 50 Best Bars three years in a row and is a pioneer in comprehensive Multisensory Mixology (MM) concept in Hong Kong. He and Tai are known for their creations of Hennessy cocktails for V.S.O.P Sunset 2019. Tai also won the 2019 Diageo World Class HK & Macau Bartender of the Year title. Prior to that, Lai also achieved significant acclaim at V.S.O.P x The Drunken Pot 2015. More information about #MYHennessyAtHome Cocktail Challenge and the Hennessy Declassified Live Masterclass can be found on Hennessy Malaysia’s Facebook page: https://www.facebook.com/HennessyMalaysia EQ Kuala Lumpur hotel mothers day 2020 Kuala Lumpur Malaysia Mother’s Day 2020 desserts macarons tea affordable digital marketing social media marketing influencer marketing

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CC-MAIN-2022-21

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2022-05-16T22:57:05Z

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Vape And Juice Vape Shop based in Kennebunk 04043 ME Vape And Juice Vape Shop based in Kennebunk 04043 ME . Shop CBD Infused Shampoo, e-liquid by top brand such as Monsta VapeMade In Malaysia E-liquid, Legendary One Offs by Vango Vapes and Tinted Brew Liquid Co. CBD Vaping - Exactly How Much is Way too much and also What You Need to Do Regarding it CBD vaping has acquired quite a great deal of appeal. The CBD fad is going and also may go a lot more with people of all generation. These days, people have extra choices to pick from. There are a number of CBD flavours that you can match and blend for vaping. Nonetheless, this has led CBD vaping one of the fastest soaked up contemporary pattern amongst middle-aged people. As per recent financial reports, there are couple of business, who have experienced a whooping revenue of over 40 percent annually. 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Various flavours of CBD oil can be used in many of the cartridges or e-vaping pen. THC vs CBD You may not be aware of it, but there are several cannabis pressures, which are produced from marijuana plant yearly. While there are some states where buying cannabis is legal, there are still couple of regions where it has actually been strictly banned, to stop the young people getting mislead. The chemical component removed from hemp does not have the very why not look here same chemical make-up as THC is missing out on. Therefore, it is offered worldwide. According to why not try here the current clinical reports, relying on the usage it can be used by everybody over 18 years old. THC is an energetic component that disrupts the chemical degrees in the mind and modifies the process of the nerve receptors. Tetrahydrocannabinol mimics the chemical composition and also goes across the brain barrier therefore providing a hyper impression of being high. 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The much less mild and air that extracted nicotine is exposed to, the higher the purity. individuals who like tobacco e-liquid really take pleasure in the creativeness that vape juice makers place into their tobacco flavors, and Here is the region in which the from this source vape juice mixologists of the planet perform most difficult to receive the regard of the vaping Neighborhood. In recent years, a whole new phenomenon generally known as nicotine salts has emerged. specified manufacturers have learned that by introducing benzoic acid to liquid nicotine, they could maximize the amount of nicotine in their products and solutions. It’s quite simple, the greater nicotine, the more robust the dependancy capabilities. Salt nicotine (as promoted) will be the product or service of incorporating acids to pure nicotine. This produces a far more addictive merchandise thanks Thot Juice eLiquid SALTS to increased quantities (an estimated two to ten moments a lot more) of tolerable nicotine. Kik offers a set of about eighty distinctive fantastic e liquids, from standard tobacco flavours to fruit eliquids and Particular e-shisha mixes. The Muffin guy is undoubtedly an 80% VG blend from a person strike speculate e-liquids, getting just above one% of the total vote in our greatest e-juice flavors poll and ranking as the 2nd-very best VG vape juice flavor. The juice is yet another apple and cinnamon blend: with a strong, sweet apple taste to the inhale accompanied by the warming flavor of cinnamon muffin – a beautiful bakery-fashion blend using a fruity twist.

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An interesting article on Penang Malaysia. Video game cheats have primarily been a plague on PC, not so much on consoles. But a new, relatively sophisticated method brings the disease to consoles. And it involves a PC, a capture card, and machine learning. The Anti-Cheat Police Department, a bunch of volunteers who look out for and disrupt cheating groups, have shared on Twitter a new kind of cheating. As mentioned, it uses machine learning, The way it works is by having the cheat analyse your gameplay in real time, and the cheat adds in inputs so that your crosshairs snap to your enemies. Because it’s not an aim bot or wall hack, you will actually have to see your enemies for the cheat to kick in. And even then, you’ll have to manually aim in the general direction of your targets until a certain threshold where it kicks in and does the aiming for you. Think of it as aim assist, but turned up to 19 and given a steroid overdose. Ladies and gentlemen, I present you the next generation of cheating now available on console, and has been for a while but lately its been becoming more popular and more of a trend, consoles are no longer a safe space to play your games legit anymore pic.twitter.com/iEQzPVFf1h — Anti-Cheat Police Department 🕵️ (@AntiCheatPD) July 5, 2021 Making this even scarier is that this is usable even on consoles. All you need is a PC that’s running the cheat, and a capture card so allow your PC to see gameplay from your console. There was a video promoting this on YouTube, presumably showcasing the cheat working in a Call of Duty. Activision has since made a copyright claim on the video, taking it down. But as Eurogamer reports, the cheat’s discord is still active, and the software is still up for sale. The good news is that it is still detectable. But even then, it will be awhile before any real action gets taken against this new breed of cheat. More so, it’s a sign of the evolution that cheats are currently going through (Source: Anti-Cheat Police Department / Twitter via Eurogamer) The above article was first provided here. I trust you found the post above interesting. You can find similar content on our blog here: Please let me have your feedback below in the comments section. Let us know which subjects we should write about for you next.

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From December 1884 to December 1885, a series of murders occurred in Austin, Texas, which became known as the Servant Girl Annihilator murders. One of the suspects was a Malay cook, known only as Maurice. Before he could be apprehended, Maurice disappeared. It is presumed he went back to the ships to work. He told his employer at the Pearl House on Pecan Street that he was going to work his way over to London. When Maurice was gone, the murders mysteriously stopped. Three years later, in 1888, the Jack the Ripper murders began. Among the hundreds of suspects was a Malay cook who called himself Maurice. A seaman named Dodge told London police that the cook threatened to kill every prostitute in London as revenge for having been robbed by one. This is Maurice’s story, from his point of view. However, Maurice is innocent, but he slowly begins to realize that the true killer is his friend and life-long companion named Mawken. How far will Maurice go to stop the bloodshed? In this fictionalized account, the author provides fresh information on the actual Austin murders that has not been previously published. He is with me always, even from the beginning. He is with me yet. I am not sure when I first became aware of him, but it was long ago when I was yet a boy. I was born in the small fishing village of Kadan Kyun on King Island across the channel from Mergui on the archipelago in Burma. I am called Maurice. You will forgive me if I use that name only. You will understand why by and by. I am Moken, although people who know no better say Malay. The Burmese of my homeland call my people Selung or Selone. After many years, I grew tired of correcting people, and now identify myself as simply Malay. For some reason, that seems to satisfy most people. I have far fewer questions now. I do not like questions. Perhaps what offends me are the answers. I was born on the island sometime around or just before 1865. My people were known as sea gypsies. They roamed from place to place, without a true homeland. We spoke a common language, but I have not used it for so long I can no longer remember. My father grew rich in the spice trade, and settled on King Island before I was born. His wealth afforded me all of the luxuries of life. I had no siblings. I had loving parents but they were very busy, and allowed me much freedom to roam. I spent my early years running free on my island and exploring the area around my home, including the heavily jungled forest. When I was old enough for school, my parents hired a teacher – an Englishwoman who taught me English, reading, and basic arithmetic. It has been so long now since I spoke my native tongue, I converse, think, and dream in the English language. I am told I have a British accent, which amazes most people. I am a brown man with an English accent, which is quite a novelty in some places it seems. At the age of ten, the local authorities, despite my race, allowed me to attend their local school. I am quite sure my father’s money had something to do with the decision. It was around that time when I first met … shall we say, “him.” Perhaps that is not the right expression; it was about that time when I first became aware of him. This is the story of myself – and of him. Of how we met and became close. How I took care of him all these years. How he became obsessed with me, and how I tried to get away from him so many times. How he always his way back into my life somehow, and how I protected him when I believed he was innocent. Mostly, it is the story of why I now sit in a darkened room, waiting for … “him” to come home, so I can kill him in cold blood. KIRKUS PREFERRED REVIEW by Ernie Lee Publisher: Aim-Hi Publishing A novel offers a new perspective on one of history’s most notorious figures. This 19th-century tale starts innocently enough with two Malay boys, lonely rich kid Maurice and Mawken, the poor local boy he befriends. At first, Maurice educates the illiterate Mawken, who in turn gives him advice. But as Maurice grows up, he yearns to strike out on his own and to leave Mawken behind. Before that can happen, the two end up on the run after the mysterious murders of their parents, supposedly by pirates and witnessed only by Mawken. The two find work on a cargo ship, with Maurice as a cook and Mawken as a crew member. Partway through the journey, Maurice witnesses Mawken kill the ship’s brutal captain, but he stupidly picks up the murder weapon and is blamed for the crime by his fellow crewmates. Luckily, a storm severely damages the ship and Maurice is briefly free of his past. Then Mawken shows up again, and death follows him, with the kindly but weak-willed Maurice unable to escape his dangerous friend: “There was no question or indication I had any recourse but to follow his plan. It was as if he made the decisions and I meekly followed.” Maurice is the unfortunate observer of a series of gruesome murders of women, first in Austin, Texas, and later in the slums of London, which leads to the Jack the Ripper mythos. The strength of Lee’s (Aquasaurus, 2016, etc.) intriguing second novel is the well-researched, vivid passages describing life aboard a cargo ship and in 19th-century Austin and London. The narrative moves along swimmingly in those parts. But the author tips his twist ending way too soon. In addition, anyone who gets close to Maurice tends to disappear quickly, sometimes permanently, while Mawken prefers to stay in the shadows (“I am not seen if I don’t want to be seen”). This means there isn’t much of a cast to experience other than the two polar-opposite main characters. The key question that remains is how long will it take Maurice to realize what readers already have. A promising thriller about a famous serial killer in which the suspense prematurely dissipates. HIM READER REVIEWS Extraordinary tale of real-life 1885 murders in Austin, Texas. Author Ernie Lee provides exciting scene-b y-scene coverage in this thrilling novel. One of the main suspects was a Malaysian ship cook named Maurice. Although Maurice was never caught or interviewed, Lee focuses on this particular suspect in his novel. By researching late 19th century sailors and ancient Malaysian forklore, Lee uncovers new evidence that has never been explored. For instance, many of the Austin victims had a hole in their head. Much speculation at the time centered on an ice pick, a long nail or spike, or a rod of some sort. Lee explains that every sailor of that era had access to a marlin spike. A marlin spike matches exactly the wounds recorded int he autopsy reports of the time. Lee describes Malaysian folk mythis of the Panaggalong, an Asian monster similar to our vampires. The difference is very interesting. The way to neutralize an European vampire is a stake through the heart; the way to eliminate an Asian vampire is a stake through the head. The remainder of the novel is fiction. Since no records exist of the real suspect, Lee fills in the blanks from his creative imagination. The thrilling murder-by-murder descriptions melds real-life with fiction, and results in an intreresting read, and a very scarey scenario. When intervied on NPR radio, Lee described the grisley killings. A must read.

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Mark your calendars for these major attractions to come. 1. 20th Century Fox World Dubai The 20th Century Fox studio has announced its foray into Dubai following its announcement of a theme park called 20th Century Fox World Dubai. Slated to open in 2018, the theme park will include attractions based on Fox productions such as Aliens, Ice Age, The Simpsons, and Sons of Anarchy. 2. 20th Century Fox World Genting On track to opening this year, 20th Century Fox World in Genting Highlands will feature rides inspired by films like Titanic, Planet of The Apes, A Night At The Museum, and Ice Age. Apart from experiencing rides inspired by top Hollywood blockbusters, park goers can also expect plenty of other attractions and dining options as the park is conveniently located within Resorts World Genting. 3. Universal Studios Beijing Expected to open as early as 2019, Universal Studios Beijing will be located in the eastern suburb of Tongzhou, with a theme park, shopping center, and hotel. According to the released concept art, the park will likely feature a Harry Potter land, a Sci-Fi city and The Lost World, and more. 4. Ubisoft Theme Park Come 2020, fans of French video game publisher Ubisoft can expect to see a first-of-its-kind indoor theme park featuring attractions related to its popular games and characters. To be located in Kuala Lumpur, Malaysia, the park will have rides and shows inspired by games including Assassin’s Creed, Far Cry, Ghost Recon, Prince of Persia, and more.

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The answer may lie not just in what you sell, but what you don’t. At its most simple level, this means keeping to your core offering and not muddying the waters by diversifying wildly into areas that would confuse your customers and prospects. The business world is littered with stories of product mismatches. One of our favorites is toothpaste brand Colgate’s baffling foray into the frozen food sector back in the 80s. It didn’t end well, although it did end mercifully quickly. An example of an e-commerce brand getting it right is The Modist (pronounced mode-ist), a women’s high-end fashion brand. Its founder, Ghizlan Guenez, had the idea of concentrating on clothes for the kind of woman who likes to express her style in a fashionable, contemporary but modest way. Women visiting themodist.com know that they won’t be offered clothing that’s inappropriate to their society or to their own values. As a result, they are an example of an e-commerce site doing great business in the UAE, other Middle Eastern countries and beyond. Another way of ensuring your site attracts the ‘right’ sort of customer is to concentrate on a limited range of products, or even just one. That way, you can be blissfully focused on your site, your marketing tactics and your goals. A couple in the US fell in love with the distinctive robes provided by a hotel during a tour of West Texas. Returning home, they decided to share the love via their pun-tastically named website, Highway Robery. What else do they stock? Nothing – just the robes. Founder Evan Streusand said, "We decided from the outset what our aesthetic was going to be, and we've held true to that since day one. What's the old cliché? ‘When you try making something for everyone, it ends up being for no one." Hair extension specialists Luxy Hair could have diversified into shampoos, brushes and clips, but instead kept to a limited range of products that they know appeals to the majority of their market. This narrow focus hasn’t stopped their annual profits reaching seven figures. History doesn’t record how many people have abandoned their e-commerce dreams right after calculating how much it would cost to build and crew a factory. But selling doesn’t always mean making, stocking or even mailing. Dropshipping is an e-commerce model where a customer’s order to an online store is passed straight on to a third-party vendor, who then ships it directly to the customer. The store owner never sees or touches the product. There isn’t even a store. But the rewards can be great. You choose the products, build the website and look after the marketing. Get it right and you could be like the founder of So Aesthetic, who made US$12k in his first month of trading. Trevor Chapman really hit the big time with his dropshipping business (despite blatantly ignoring our ‘less is more’ advice!), reaching his first US$1m in just 90 days. Unsurprisingly, not all suppliers are happy to enter into a dropshipping agreement. But the potential is clearly there. Are you planning to ship globally? Just as Ghizlan Guenez takes care not to stock products that would alienate her customers, e-commerce retailers should be aware of which products are banned or restricted in certain territories. There are the obvious contentious products such as guns and drugs. The ban on chewing gum in Singapore is well known. But what about baby walkers? Outlawed in Canada. Sodas? If they contain something called BVO, like America’s Mountain Dew, you can’t sell them in Europe or Japan. Wheelbarrows? You’re safe everywhere except Nigeria. Meanwhile, Saudi Arabia’s customs officials keep a watchful eye out for masquerade masks, Valentine’s Day gifts and any greetings cards that play a little tune when you open them. Exporting globally involves grappling with a whole world of certificates, compliances and complications. Fortunately, help is at hand in the form of country guides on trading internationally. Unless your products capitalize on their country of origin, such as French cheeses or Peruvian ponchos, you may wish to localize your presence in overseas markets. If so, consider local country codes for your website, such as .au for Australia or .my for Malaysia, and use images that are appropriate to local tastes and sensitivities. At the very least, you should translate your copy. In a recent survey, 55% of respondents said they would only buy from websites where information was available in their own language. Avoid automatic translation engines, and instead hire a native translator to achieve a more natural, nuanced feel to your copy.

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Named after Malaysia’s former Deputy Prime Minister, Taman Tun Dr. Ismail, and commonly known as TTDI, is one of Kuala Lumpur’s prime areas of real estate — but we’re here for the food. The area’s evolution into a thriving yet laid-back neighbourhood that merges residential areas with cultural happenings and dining destinations makes it our kind of hangout. From local hawker joints to modern restaurants and a bustling café scene, TTDI is a place where cool spots are discovered and bookmarked. Consider this a cheat sheet for your next visit. The menu at Alibaba & Nyonya is teeming with Malay classics and Peranakan favourites, and at first glance, might leave you with choice paralysis. However, this TTDI restaurant has done a great job showcasing the nostalgia and charm of traditional Malay and Peranakan cooking, and our tip is to dive straight into the carbs and main dishes. The Nyonya Mee Siam (pictured top) is a pleasant take on a classic, with vermicelli and crispy bean sprouts doused in a slightly sweet tomato chilli sauce, accompanied by giant plump prawns. Looking for something more substantial? The Nasi Ulam Ayam Dara features a fragrant herb rice salad, with a side of fried-to-perfection kampung chicken, and comes highly recommended by the chef. Pricing: from RM30-40 for a full meal with dishes Phone number: 3-7732 3170 Opening hours: Monday–Sunday: 11am-10pm It may be one of the most popular durian stalls in Klang Valley, but Durian King TTDI sure is inconspicuous. Located in the carpark adjacent to the TTDI wet market, Durian King is famed for its wide selection of the King of Fruits. From the crowd-favourite D24 to the more exotic Black Thorn, a highly sought-after variation of the fruit, Durian King TTDI has made a name as a one-stop shop for all your durian cravings. Another reason to seek out this roadside stall is the cendol, topped with thick amounts of golden flesh — it’s a treat that Durian King has perfected. For a refreshing fix on a hot day, go for the Musang King cendol that hits all the right spots. Picture this: sweet and creamy durian flesh, sitting atop a bed of shaved ice, mixed with green cendol, corn and red beans, drizzled generously with fresh coconut milk and thick, dark palm sugar. It’s as epic as it sounds. Pricing: from RM15-25 for the durian cendols Phone number: 016-274 6474 Opening hours: Monday–Friday: 3pm–12am; Saturday–Sunday: 12pm-12am If you’re in the mood for quick and casual Malay food in TTDI, Dua by Skohns offers dishes with comfort factor, as well as modern Western fare tweaked for the local palate. All plates here — from the nasi lemak and nasi bojari, to fusion specials like lamb shank briyani and grilled lamb chops — are presented clean and simple. Our pick is the famous Nasi Kerabu (butterfly pea flower rice) Ayam Percik, and crunchy herb salad, paired with a fiery sambal tumis that leans towards the side of spicy, perfect for those looking for an extra kick. We’re sliding this into the guide especially for fans of good cheap eats: with lunch sets going as low as RM10 on weekdays, it’s hard to find fault with the hearty portions and price tags that are easy on the pocket. Pricing: from RM15 for a meal with drinks Phone number: 3-7731 6954 Opening hours: Monday–Wednesday: 12pm-3pm, 6pm–10:30pm; Thursday-Friday: 12pm-3pm, 6pm-11pm; Saturday: 12pm-11pm; Sunday: 12pm-10:30pm Besides gaining attention for its colourful murals and cosy Instagram-worthy nooks, Little Rimba is also known for dishing up comfort fare in a bright, cheerful space (hello natural light!). Distinguishing itself from its sister establishments around town, the menu at this TTDI café is the best of both worlds: it’s peppered with Western faves and local temptations that we promise will pique your interest. We say throw out the rule book by having beef aglio olio pasta and Laksa Nyonya all in one sitting. Why fret over choosing between sweet and savoury? Pricing: from RM20 for a meal with drinks Phone number: 3-7733 6177 Opening hours: Monday–Sunday: 7:30am-6:30pm Common Man has fast become an institution in the TTDI neighbourhood since its opening three years ago. Offering sustainably sourced specialty coffee beans, roasted fresh and brewed in myriad ways, this is where serious coffee lovers flock to for their daily cuppa. As a coffee brewer and café that takes pride in the journey from bean to cup, Common Man never disappoints with its top-notch pour-overs, flat whites, and distinctive nitro cold brews. For those who want to take coffee appreciation to another level, the exclusive UnCommon range allows you to choose from an exotic selection of exceptional beans with a unique origin character. Beyond winning the hearts of coffee lovers, Common Man does it all with a house-made nitro iced tea that comes in seasonal flavours, creamy chai lattes, as well as delicious smoothies that are perfect as post-workout pick-me-ups. Pricing: from RM9-20 for a cup of coffee Phone number: 3-7731 7095 Opening hours: Monday–Friday: 8am–5pm; Saturday–Sunday: 8am–6pm (last orders at 5.30pm) HUNGRY FOR MORE?

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Get to your connections quick and easily with Grab! Enjoy a comfortable journey to and from the airport with RM10 off two rides. Prefer to stay on track? Get RM5 off two rides to all intercity KTM stations and transit hubs! Simply enter the promo codes below: - 2x RM10 off all airport rides in Malaysia with the promo code: AIRPORT - 2x RM5 off rides to intercity KTM stations and major intercity transit hubs in Malaysia with the promo code: TRANSIT List of applicable airports, KTM stations, and transit hubs: |Alor Setar||Sultan Abdul Halim Airport||KTM Alor Setar KTM Anak Bukit Jeti Kuala Kedah |Batu Pahat||–||Terminal Bas Express Batu Pahat| |Bintulu||Bintulu Airport||Bintulu Sentral Bus Terminal| |Ipoh||Sultan Azlan Shah Airport||Terminal Amanjaya |Johor Bahru||Senai Airport (JHB)||JB Sentral Stesen Bas Ekspres Kangar KTM Padang Besar Terminal Feri Kuala Perlis |Kemaman||Kerteh Airport||Stesen Bas Ekspress Geliga Stesen Bas Dungun |Klang Valley||Kuala Lumpur International Airport (KLIA) Terminal Bersepadu Selatan (TBS) |Kluang||–||Stesen Bas Kluang |Kota Bharu||Sultan Ismail Petra Airport||Stesen Bas Kota Bharu KTM – Wakaf Bharu Terminal Bas Kota Bharu KTM Tanah Merah |Kota Kinabalu||Kota Kinabalu International Airport (KKIA)||Inanam Bus Terminal| |Kuala Terengganu||Sultan Mahmud Airport (TGG)||Hentian Bas MBKT| |Kuantan||Sultan Ahmad Shah Airport||Terminal Sentral Kuantan |Kuching||Kuching International Airport (KIA)||Kuching Sentral| |Labuan||Labuan Airport||Labuan Central Bus Station| |Lahad Datu||Lahad Datu Airport||Terminal Bas Lahad Datu| |Langkawi||Langkawi International Airport||Langkawi Kuah Jetty| |Melaka||Melaka Airport (MKZ)||Melaka Sentral| |Miri||Miri Airport||Miri Bus Terminal| |Muar||–||Perhentian Bas Bentayan| |Negeri Sembilan||–||Stesen KTM Seremban KTM Batang Benar Bus Station Seremban |Penang||Penang International Airport (PIA)||Penang Sentral KTM Bukit Mertajam Terminal Bas Ekspress Sungai Nibong |Sandakan||Sandakan Airport||Bus Station Labuk| |Sibu||Sibu Airport||Sibu Bus Terminal Terminal Bas Ekspress Sarikei |Sungai Petani||–||KTM Sungai Petani Terminal Bas Ekspres Ukir Square |Tawau||Tawau Airport||Stesen Bas Express Tawau Tawau Ferry Terminal Terms and conditions: - Valid for selected areas only (airports and intercity transit hubs) in Malaysia only - This promotion is valid for all hours, from 9th March – 7 April 2020. - This promotion is valid for all payment methods. - If the fare is less than the promo amount, there will be no reimbursement of the fare difference. If the fare is more than promo amount, the additional fare amount will be charged to the Grab user. - A cancelled booking (either by passenger or driver) nullifies the promo entry. - The promotion discount is only successfully redeemed once a relevant in-app message is received (after successfully being allocated a car by the system). - All bookings must be made via the Grab App. - Not valid with other promotions. - What do I get with this promo? With this promo, you will get RM10 off x 2 rides to/from all airports in Malaysia and RM5 off x 2 rides to/from all major intercity transit hubs in Malaysia. For a full list, please refer to grb.to/travel - How many times can I use this promo code? You may use the promo code at a maximum of 2 times per promo from 10 March – 8 April 2020. - What are the payment methods that I can use? Its valid for all payment types. - Is there a limit to the number of people who can enjoy this promo? This promo is limited to the first 6,700 rides daily per promo and 201,000 throughout the campaign period per promo.

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A second Russia Today correspondent has quit her job, saying the Kremlin-funded station's anchors "do work for" Russian President Vladimir Putin and lied on-air to the public. London reporter Sara Firth announced her resignation nearly two hours after taking to Twitter in a conversation with Russia Today's London correspondent Polly Boiko, The Huffington Post reported. Firth said the network asks its anchors to "obscure the truth," and that she'd had enough. : This Little-Known Website Can Erase $100,000 of Debt The conversation popped up after another Twitter user complained to Boiko about the network's coverage of after a suspected surface-to-air missile brought down Malaysia Airlines Flight 17 as it flew from Amsterdam to Kuala Lumpur: When Boiko asked Tanos what she is spreading, Firth popped in with a tweet accusing the London anchor — and herself — of lying on a daily basis, saying: She told The Press Gazette in London that she made her decision to quit Thursday after her newsroom's response to the reports about the deadly plane crash. "Yesterday when the story broke you get the kick in your stomach when you’re going to get the facts and it’s this huge story," she said. "And I walked into the newsroom and they were running an eyewitness account of God-knows who the person was blaming the Ukrainian government, and it is such a volatile situation." Firth, who has been with Russia Today since 2009, told BuzzFeed Friday that the organization's coverage of the crash was "the total disregard to the facts. We threw up eyewitness accounts from someone on the ground openly accusing the Ukrainian government [of involvement in the disaster], and a correspondent in the studio pulled up a plane crash before that the Ukrainian government had been involved in and said it was 'worth mentioning.' " But the prior plane crash wasn't "worth mentioning," Firth said. “I couldn’t do it any more," Firth said. "Every single day we’re lying and finding sexier ways to do it.” Earlier this year, former Russia Today correspondent Liz Wahl quit while she was on the air, saying she couldn't support a network that "whitewashes the actions of Putin" while asking her to "promote Russian foreign policy." Special: Billionaires Are Quietly Buying These 5 Stocks © 2022 Newsmax. All rights reserved.

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To help you plan your next ski holiday, here’s our guide to the best ski resorts in France. France is rightfully one of the most popular ski destinations for British skiers due to its picturesque scenery and varied ski areas. From high altitude ski resorts with excellent snow to traditional Alpine towns, the ski resorts in the French Alps have it all. We have selected the 10 best ski resorts in France for you below. Ski area: 300km Located at the end of the Tarentaise valley, Val d’Isère in France offers access to the renowned Espace Killy ski area. With 300km of slopes and 158 runs, this is one of the best ski resorts in France for mixed-ability groups. There’s something here to suit everyone, from the challenging Face de Bellevarde piste, to the gentler cruising slopes in the Solaise sector. The French ski resort is also well known for sport, having hosted the World Alpine Ski Championships in 2009, and the Critérium de la Première Neige competition every year since 1955. Local restaurants serve up an abundance of rustic Savoyard cuisine, and après ski options include the legendary Dick’s Tea Bar. Ski area: 600km Perched at a lofty 2,300m at the head of the Belleville Valley, Val Thorens has the honour of being the highest ski resort in Europe. The French ski resort has access to more than 600km of linked pistes across the Three Valleys ski area with some of the best skiing in France. There’s a wide variety of ski terrain here, from gentle nursery slopes to blacks and challenging glaciers. At 3,200m, the top of the Cime de Caron is not for the faint of heart. Those who brave the cable car journey will be rewarded with some incredible panoramic views of the surrounding peaks. If you enjoy post-ski nightlife, this is one of the best ski resorts in France. The largest nightclub in the Alps, Malaysia, is found here, along with the highest pub in Europe, the Frog and Roastbeef. Ski area: 600km Courchevel is a Ski Solutions favourite and has to be one of our top French ski resorts. Part of the Three Valleys ski area – the biggest ski area in France. Courchevel is made up of four different ski areas each with their own distinct feel. Courchevel 1850 with excellent skiing and chic boutiques. If you’re looking for a lively atmosphere and a great selection of shops and bars, try Courchevel 1650. Otherwise, Courchevel 1550 with a relaxed atmosphere or Courchevel 1300 with an authentic Alpine village. Named one of the most exclusive ski resorts in the world with an abundance of Michelin-star restaurants for you to enjoy, Courchevel is the perfect choice for a stylish ski holiday. Ski area: 225km La Plagne is one of the best ski resorts in France. Made up from ten separate villages, the French ski resort offers multiple ski experiences depending on which you choose to stay in. Montchavin is a great family favourite with its snow garden and sledge area. Belle Plagne and Plagne Centre are the best villages for lively pubs and late-night discos. With access to the vast Paradiski ski area, there is a variety of terrain to keep everyone happy too. The bobsleigh from the 1992 Winter Olympics is a must-do, with three different tracks winding down a 1.5km track from Plagne 1800 to La Roche. One of our sustainable choice ski holidays, taking the train is the most environmentally friendly way of travelling to this resort. Ski area: 650km One of the best ski resorts in France, the small and picturesque village of Les Gets started life as a dairy farming village in the 12th century. The ski resort still retains a rustic charm that sets it apart from the larger purpose-built resorts. There are 650km of pistes to choose from in the Portes du Soleil ski area, with an abundance of intermediate slopes, 66 groomed trails and 12km of cross country skiing. The resort has a reputation for being family-friendly and has a P’tits Montagnards award for child care, as well as a Family Plus Mountain Award. Along with a good selection of bars and restaurants, the quaint town has some traditional Savoyard shops selling French bread and cakes and locally cured meats and cheeses. Ski area: 650km Morzine is a wonderful Alpine town with traditional chalets around a village square. Located in the heart of the Portes du Soleil ski area, Morzine’s setting allows you to ski in both France and Switzerland on the same day. With 600km of skiing to explore, there is something for all skiers. Morzine is a lively town with plenty of après ski options after a day on the slopes. Alongside a plethora of bars and restaurants you’ll find lovely spas and ice climbing, ice skating, tobogganing and snowmobiling too. This really is one of the best French ski resorts. Ski area: 125km La Clusaz is one of the best ski resorts in the French Alps. This traditional French village is bursting with Alpine charm complete with a pretty square and Savoyard church. The ski area has 125km of slopes and is well suited to beginners and intermediates. There’s plenty of excellent off-piste to keep advanced skiers busy around the La Balme ski area. The village itself is home to delicious Savoyard restaurants and rustic bars to while away the evening in. Located just one hour from Geneva, this is a great ski resort for a weekend away in the France. Ski area: 300km One of the 10 best ski resorts in France, this high-altitude ski resort has some of the most impressive snow coverage in Europe. Located in the Espace Killy ski area alongside Val d’Isère, skiers can access over 300 km of pistes as well as 10,000 hectares of off-piste terrain. Tignes is split up into villages with varying altitudes. With wide pistes and skiing to suit all abilities, there will be a run that offers a challenge for all skiers. Ski area: 150km Located just 1hr 30mins from Geneva airport, Chamonix is ideal for a short break in the French Alps. The ski area has access to over 150km of piste. This stylish town can be found nestled at the bottom of the iconic Mont Blanc. With a history that harks back to the 19th century, it is one of France’s oldest resorts. The French ski resort is perfect for skiers looking for challenging terrain on and off piste. In town, the atmosphere is lively with a variety of restaurants, shops and après bars to sample. Head into Chamonix’s pedestrianised centre that stays alive well into the night. For those seeking a more relaxed experience, the bars, shops and restaurants in the resort’s town centre won’t disappoint. Ski area: 223km One of our 10 best ski resorts in France, this high-altitude ski resort in the south of France has Europe’s largest skiable glacier. Les Deux Alpes also boasts one of the world’s greatest on-piste vertical drops: an exhilarating descent of 2,268m. The ski resort has one of the largest snow parks in the French Alps and offers a wealth of impressive off-piste terrain. With slopes to suit all levels, the Les Deux Alpes ski area is an ideal choice for mixed ability groups. Renowned for its lively après-ski and nightlife, there are plenty of bars and restaurants for all budgets. This is one of the best French ski resorts. To find out more about the 10 best ski resorts in France, view our French ski holidays here. Alternatively, speak to our experts on 0207 471 7700 to find out more about the best French Alps ski resorts in the finest ski areas. Other posts you may like:

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Chinese President Xi Jinping, who begins a U.S. visit Tuesday, said his government takes cybersecurity seriously, and that cyber criminals, including hackers stealing commercial secrets, should be punished according to the law and international conventions. In written comments published early Tuesday in response to questions from the Wall Street Journal, Xi said China has also been a victim of hacking and denied any governmental role in stealing business data. "The Chinese government does not engage in theft of commercial secrets in any form, nor does it encourage or support Chinese companies to engage in such practices in any way," Xi wrote. On Monday, U.S. National Security Advisor Susan Rice warned China that Beijing-sponsored cyber espionage is a major stumbling block to U.S.-China relations, and said such spying must stop. Xi told the Wall Street Journal he is ready to boost cooperation with the U.S. on the issue of cybercrime. He also discussed the disputed islands in the South China Sea known in China as Nansha and elsewhere as the Spratly Islands. Xi asserted that the chain, also claimed in part by the Philippines, Vietnam, Malaysia, Brunei and Taiwan, has been Chinese territory since ancient times. China has been carrying out land reclamation projects, as well as building civilian and military facilities. "China's development and maintenance of facilities on some of our garrisoned islands and reefs in the Nansha islands does not impact on or target any other country, and it should not be overinterpreted," Xi said. The U.S. has demanded China stop those activities, calling them out of step with international norms and a risk for sparking conflict in the region. Xi noted the large proportion that China and the U.S. account for when it comes to the world's population, economy and trade, and said the two countries should "understand and respect each other" while taking into account each side's interests and concerns. "If two big countries like ours do not cooperate with each other, just imagine what will happen to the world. Both history and reality show that China and the United States stand to gain from cooperation and lose from confrontation." He noted areas where China and the U.S. have come together on the world stage, including concerns about nuclear programs in North Korea and Iran, peace talks between Israel and the Palestinians, the situation in South Sudan and climate change. Xi said there are differences, but that those reasons are why they should "complement each other and find best solutions to issues."

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Scientific name: Moringa oleifera (M. Oleifera Lam. (Shigru) Common names: Horseradish tree, Mother’s Best Friend, Radish tree, Drumstick tree, West Indian ben oil tree, Benzoil tree, Subhanjan, Mukhabhanga, Sheeghrak, Krishnagandha, Teekshnagandha, Shwetak, Raktak, Mochak, Dansha, Shigruk, Ghanapallav, Swadugandhee, Moolakparnee, Shaigrav, Murangee, Moolakchchada, Shobhanjan, Avadanshaksham, Teekshnagandhak, Vidradhighna, Aksheev, Madhugndhik, Shwetamarich M. Oleifera Lam. (Shigru) (Horseradish tree – syn. M. Pterygosperma Gaertn. Indigenous northwestern sub-Himalayan India), M. Arborea Verdc. (Kenya), M. Peregrina (Forssk). Fiori (indigenous Horn of Africa and Sthn Sinai, Egypt), M. Longituba Engl. (indigenous Ethiopia and Somalia), M. Drouhardii Jum.- Bottle tree (indigenous southwestern Madagascar), M. Rivae Chiov. (indigenous Ethiopia and Kenya), M. Ruspoliana Engl. (indigenous Ethiopia), M. Concanensis Nimmo (indigenous northern India), M. Borziana Mattei (indigenous Somalia), M. Hildebrandtii Engl. (indigenous southwestern Madagascar), M. Ovalifolia Dinter & A. Berger (indigenous Namibian and Angola), M. Pygmaea Verdc. (indigenous Somalia), M. Stenopetala (Baker f.) Cufod (indigenous Ethiopia and Kenya). Assamese: Sojina, Sajina, Sohjna Bangladesh (Asia): Sajina Bengali: Sojne danta, Sejana, Sajina Benin (Africa): Ewe ile, Patima Brazil (Sth America): Cedro Burkina Faso (Africa): Argentiga Burma (Asia): Dandalonbin Cambodia (Asia): Ben aile Cameroon (Africa): Djihire, Paizlava Chad (Africa): Kag n’dongue Chinese: la mu (Mandarin); lat mok (Cantonese) Costa Rica (Central America): Marango Côte D’Ivoire: Arjanayiiri (Dioula) Cuba (Central America): Palo Jeringa Dominican Republic (Central America): Palo de Aceiti El Salvador (Central America): Teberinto Ethiopia (Africa): Haleko, Aleko French: Arbre radis du cheval, Benzolive, Ben aile, Ben oleifere French Guiana (South America): Saijhan German: Behenbaum, Pferderettichbaum, Behenussbaum, Behenbaum, Flugelsaniger Bennussbaum Ghana (Africa): Ewe Yevu-ti, Zingeringende Guadeloupe (Carribean): Moloko Guatemala (Central America): Perlas Guam (Oceania): Katdes, Malungay Gujarati: Saragvo, Sargosha, Sekato Hausa: Samarin, Sijan Hindi: Sahjan, Sahijan, Sajana, Munaga Honduras (Central America): Maranga calalu India: Murunga, Moonga, Sahjan Indonesian: Kelor, Kalor Italian: Sàndalo ceruleo Kannada (Asia): Nugge kayi, Nugge mara Kenya (Africa): Mborongi, Mronge Konkani: Mushinga Saang, Mosing, Moosing Malawi (Africa): Kangaluni, Cham’mwanba Malayalam: Muringa, Sigru, Muringa, Murinna, Morunna Malaysia: Kachang Kelur Mali (Africa): Nevrede Marathi: Shevaga, Sunja, Shevga, Shivga Mooré (Burkina Faso): Arzan Tiiga – meaning ‘tree of paradise.’ Nepali: Sajiwan or Swejan Niger (Africa): Zogla gandi Nigeria (Africa): Adagba Malero (Yoruba), Ewe ile, Bagaruwar maka Odisha: Sajina, Sajana or Sujuna (Odia), Munigha, Sajina Palau (Oceania): Malungkai Panama (Central America): Jacinto Phillipines: Malunggay (Tagalog), Mulangai Portugese: Acacia Branca, Moringuiero, Cedra (Brazil), Muringa, Marunga Puerto Rico (Central America): Resada Punjabi: Saajinaa, Sanjina, Soanjana, Surajana, Sohanjana Rajasthan: Lal Sahinjano; Moringa pterygosperma Gaertn. (White var.) Siddha/Tamil Murungai; Moringa cancanensis Lamk Shigru (Red var.) Siddha/Tamil Kaatumurungai Sanskrit: Shigru, Sigru Shobhanjan, Mongna, Sahijan, Monaga, Saijan, Shobanjana, Sobhan jana Senegal (Africa): Sap-Sap Sindhi (Asia): Swanjera Somalia: Mlonge, Dangap Spanish: Árbol del ben, Moringa, Arbol do los aspárago, Morango Sri Lanka: Murunga Sudan (Africa): Ruwag Suriname (South Ameria): Kelor Taiwan: La Mu Tamil: M. oleifera – Murungai; M. cancanensis Lamk (Rajasthan and Peninsular India) Siddha Tamil- Kaatumurungai Tagalog: Kalungai; Malunggay Tanzania (Africa): Mlonge Thai: ma rum Togo: Mágurua maser Tamil: Murungai Maram, Kaatumurungai, Murangi, Murangai, Murunkak-kai, Morunga Telugu (Asia): Monaga Aku, Mulaga, Munagakaya, Munagachettu, Munaga, Sajana, Tella-Munaga Thai: กาแน้งเดิง Ka naeng doen, Marum Togo (Africa): Baganlua, Yovovoti Trinidad (South America): Saijan Vietnam: Chum Ngay Yoruba-Nago: Ewé oyibo (White man’s tree) Zarma (Niger): Windi Bundu Zimbabwe (Africa): Mupulanga Approximate number of species known: 13 with M. oleifera, M. stenopetala, and to a much lesser degree M. concanensis and M. peregrina being the most common Common parts used: Leaves, pods, kernels, oils, flowers, bark, sap, root Height: up to 10-12m (32-40ft), diameter of trunk 1.5ft (50cm) Actions: Insulinotropic, Anti-inflammatory, antimicrobial, spasmolytic, bronchodilator, mast cell stabilizer Beta carotene, Vitamin A (8855 IU per 100gm) B Vitamins including B1, B2, B3 Vitamin C (185mg per 100g) Minerals – Iron (4mg per 100g), Calcium, sodium, phosphorous, manganese, potassium (337mg per 100g), magnesium, small amounts calcium oxalate, zinc. Phenolics, saponins, quercetin, glycoside, beta-sitosterol, kaempferol, cholorogenic acids, alpha tocopherol, gum, essential oils, all amino acids with the three highest usually, arginine, glutamic acid, spartic acid. Linoleic acid, oleic acid, palmitic acid, linoleic acid, stearic and deic acid, zeatin and caffeoylquinic acid. Pterygospermin and spirochin. Considered to have low levels of anti nutrients. Flowers, Pods & Leaves – High levels vitamins A, B and C, alpha-tocopherol, pyridoxine, riboflavin, folic acid, beta-carotene, nicotinic acid, calcium, iron and ascorbic acid. Pods – Wonderful source of essential amino acids. Leaf: Excellent levels of iron and protein; mustard glycosides; nitrile glycosides, niazirinin and niazirin; leaf Powder/Paste: Alkaloids 0.1%. Seed – (common name – Benjamin). The seeds are about 35% protein, 15% carbohydrates and 15% fat. Vitamin C, B and minerals. Sometimes roasted like nuts. Contain oil used in hair oils and suntan lotion. The seed oil is able to be used for cooking. 40% contains high amount of behenic? Acid also called ben oil which is clear, colourless and impossible to become rancid. Bark – moringine, moringinine Bark Powder- Glycosides >5% Stem – 4-hydroxy-mellein?, vanillin, b-sitostenome, b-sitosterol Roots contain high amounts of poly phenol methone can be released from the leaves, beta sitosterol, zeatin, kaempferol, copper, fiber, caffeyquinic acid, pterygospermn (anti fngal) Pterygospermin and spirochin (antibacterial principles) valuable in fighting both Gram-negative and Gram-positive bacteria. Pterygospermin, benzylisothiocyanate and spirochin in roots are also considered antiviral and anticholeric. Mustard oil glycosides demonstrate spasmolytic activity along with bracycardiac and hypotensive outcomes so leaves are some times used in gastrointestinal motility complaints It is native to the Himalayas and north west India, originally from Tamil Nadu and now found in many tropical areas in the world. It is prone to caterpillars that feed on the bark and fruit flies, and termites. As the taste of the leaves is similar to horseradish, it has been called ‘Horseradish tree.’ The long, thin triangular seed pods have earned the tree the name ‘Drumstick tree’. It is also known as ‘Ben oil tree’ from the seed oil. It is a graceful, fast growing small to medium, drought friendly tree with sparse foliage that is evergreen in tropical areas but temperate climates. Prefers neutral to slightly acid and tolerates poor soils. Branches fragile and droop. It grows often with a fork near the base. The trunk is straight and up to 40cm diameter, growing up to 2 metres before lateral branches develop. The crown is umbrella shaped open and wide. There are spreading slim cylindrical branches. Bark : Dark grey, soft, corky and yellowish producing white gel. Wood is soft. Leaves : Foliage is sparse. Leaves tri-pinnate, alternate and 30.5-61cm and possibly up to 90cm long are spaced about 5cm apart up the centre stem. Small leaflets usually under 2.5cm long are often rounded-elliptic, dark green above and pale on the underside, and in opposite pairs, are arranged spirally around branches. Old leaves fall off quickly. Flowers : The tree flowers throughout the year, either annually or biannually depending on climate such as rainfall. Flowers are 25mm diameter, laxly arranged in panicles 10−30 cm long that droop. They are pentamerous and zygomorphic, sweetly fragrant, creamy white in colour with 5 petals of unequal size. Sepals are finely hairy, pale green and 12cm in length. There are 5 stamens each with and without anthers. They are bisexual and insect pollinated. Pods: Pods are 1.0-1.5cm diameter, distinctive with longitudinal furrows and from 22.5-50cm, possibly up to 90cm -120cm long, tapering to a point. Each side of the triangular, cylindrical, pendulous greenish-brown pod has 2 grooves. Seeds: Slightly bitter, blackish oily seeds trigonus 0.3–.5 wide x 0.5-1cm long, with 3 papery wings are exposed when the pod splits along each angle. Root: − White covered with light grayish-brown thin, rough bark which peels off in small pieces. Transverse row of lenticels mark the reticulated external surface. Moringa hildebrandtii resembles the baobab tree (Adansonia) that also grows in Madagascar, but is unrelated. The trunk of the tree is extremely ballooned, grows up to 20 meters tall and stores water. The leaves up to a metres long are pinnately compound. It has red leaf rachis and tips on the stems of young plants. There are large sprays of small whitish flowers. A traditional Indian vegetable, medicinal plant and a source of vegetable oil, the name Moringa come from the Tamil word “Murungai” referring to the twisted pod. It is mainly produced in India, Pakistan and Afghanistan, although it has spread worldwide. It’s high nutritive value, and purported many and varied aspects of health benefit have made it highly used in the developing world particularly for mothers and children. In the developing world it has been referred to as the “immortal fruit” or the “tree of life.” In India it is mainly produced in Andhra Pradesh, Karmataka and Tamil Nad. In addition to medicinal application it’s been used as an anti septic and to purify water. Traditionally it’s been used to treat up to three hundred diseases by native populations. The Ayurvedic Indian system has linked it with helping almost too many conditions to mention. It’s been suggested it may be beneficial for the lungs, to increase breast milk productivity, anaemia, joints, a very mild sexual stimulant, thyroid regulation, and to make the bones more resilient to infections perhaps by immune modulation. All the parts of the tree have been reported to be of benefit to health including as a circulatory and cardiac stimulant. Chronic inflammation has benefited from use of the extract which also has antipyretic activity. Other people have linked as an anti inflammatory, as an anti-hyperglycaemic, it’s been linked to a reduction in blood sugar levels, and as an anti-oxidant. Moringa has been linked to a reduction in cholesterol levels. In 2008 the NIH called Moringa the botanical of the year for its potent nutritional potential for humanity to stave of malnourishment in impoverished countries. It’s been linked to being useful in hypertensive care and gastric ulcers. It’s been suggested women who have Moringa during pregnancy will have a baby with higher body weight and during lactation will produce more milk. Most parts of the plant have been used in cases of fistula piles and internal abscess. It’s been suggested to be useful for tape worms. It’s also been used for bone density, sore gums, to strengthen the eyes and the brain. The oil has been rubbed onto the skin to function as a mosquito repellent. Thought to be useful to check diarrhoea as well as improve semen quality and sperm count. It’s been used for an electic purpose in Indian medicine as diverse as lowering cholesterol and losing weight, eyes, thyroid, fertility, aphrodiasiac, leucorrhea, meanstrual pain, spleenomegaly, jaundice, bloating, constipation, worms, skin tumours, dibetes, heache ache, spinal cord pain In the Ayruvedic system they divide it into black, red and white varities. In Niger the wood of Moringa oleifera is used for fence posts and hence is called ‘Windi Bundu.’ Further specific parts of the tree have been believed to benefit specific conditions: Bark is thought to be antibacterial and anti-inflammatory. Moringa in food The seeds and leaves have been used in food extensively and as soups and curries. The leaves are considered the most nutrient dense part of the plant. The leaves are used in salad very much like Spinach. It’s been used to restore the body in times of malnourishment. It’s not used as much as a natural medicine, more as a food with all parts of the plant being eaten raw or cooked, including the seeds which are eaten when cooked. A south Indian soup (Sambar) and also chutney is made from the leaves. The drum stick fruit meat along with seeds being used for soup in Myanmar. The young leaves may be fried with shrimp and used atop fish soup. In Niger, the Zarma word for leaf is tantamount to that of cooked moringa leaves as it is the primary part eaten. The leaves are used for tea and can be a replacement for milk as it has 4 times the amount of calcium. It also has double the protein of yoghurt. Moringa as a water purifier In Fiji and Africa it’s been used a water purifier, just as women in ancient Egypt reportedly used, where they rubbed the seed on the clay water pots. It is noted that over time, the crushed seed has been utilised as a handwash. The Moringa seed is used as a low-cost water treatment due to its positively-charged protein called the Moringa Oleifera Cationic Protein (MOCP which kills some microbes and makes them clump together, after the crushed seed is added to water. Water treated this way cannot be stored as the organic matter remaining from the seed is a food source for bacteria. This treatment obviates the need for chemicals. It is both anti-microbial and removes turbidity (coagulant). The seeds are removed from the pod. The coating of the seeds are removed to reveal the kernel. The discoloured seeds are discarded. One seed is used for one litre of water, if water is very contaminated. If water is mildly contaminated, 1 seed for every two litres of water. The seed is then crushed, mixed with water, and the powder now in water is sometimes filtered through a mesh. The seed powder, now mixed with water to make it a liquid, and sometimes filtered is added to water to improve the water, then allowed to settle at bottom by the force of gravity, It’s not just bacteria its been linked to reducing in drinking water, but also heavy metals. It also reduces total solids, and total dissolved solids. When treating with the seed the alkalinity reduces at a rate of 50mg/l then increases at 100-150mg/l. Moringa however decreased the chlorine, so it has been suggested to use chlorine and Moringa together. A natural way to process the water is to attach the MOCP to sand grains, causing the bacteria to stick to the sand in the unsafe water, then when the water is removed it is able to be stored and the sand rinsed and used again. Moringa oleifera as an antimicrobial Aqueous seed extracts above 56 deg.C as well as fresh leaf juice have been shown to impede the growth of Pseudomonas aeruginosa and Staphylococcus aureus in studies of the antimicrobial effects of Moringa O. Seeds, bark, leaves and roots, against helminths, dermatophytes as well as other pathogens to man such as yeast and bacteria. Moringa Oleifera antibacterial and antifungal Components including 4-(a-L-rhamnopy-ranosyloxy) benzyl glucosinolate plus its cognate isothiocyanate especially were found to be effective against bacteria and fungi levels. Moringa Tree Foundation, Seeds of Hope, www.Moringatreefoundation.org Moringa Oleifera as a water purifier Streptococcus faecalis and clostridium perfringens, vibrio cholerae bacteria removed in water purification at 30 deg.C with Moringa O. using seed material to coagulate, similarly to that employed in Sudanese villages. Bacterial reduction of 90-99% was achieved within 2 hours although Salmonella typhimurium and Shigella sonnei regrew consistently in the supernatant water. Moringa O. was used by flocculation to remove Schistosoma mansoni cercariae from both clear and turbid water, reducing levels by more than 90%. Moringa O. leaf nutrients Moringa O. leaves were shown to have nutrients of value able to supplement daily diets. Results using standard analytical methods were: calcium 2,009mg/100g, iron 28.29 mg/100g, crude fat 2.23%, moisture content 76.53%, crude protein 27.51%, crude fibre 19.25%, ash 7.13%, carbohydrate 43.88%, calories 1296kj/g. Moringa O. and oxidative damage Leaf extract of Moringa O. of both tender and mature leaves showed potent antioxidant activity necessary to prevent infection and degenerative disease with strong scavenging effects on 2,2-diphemyl-2-picryl hydrazyl (DPPH) free radical, nitric oxide radical, superoxide and inhibition of lipid per oxidation in in vitro models. Moringa O. and prevention of hepatic injury Pre-treatment with Moringa O. restored levels of glutathione similarly to treatment with silymarin in the face of acetaminophen (APAP) overdose (3g/kg body weight) in rats. Levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were also reduced, showing the hepatoprotective ability of Moring O. Administration of Moringa O. extract and silymarin, decreased liver lipid peroxidation, and hepatic marker enzymes while improving antioxidant levels in rats who had been given antitubercular drugs (isoniazid, rifampicin, and pyrazinamide). Moringa O. as chicken feed Broilers could be fed up to 5% Moringa leaf meal as part of a cassava based diet without a negative effect. Olugbemi, T., Mutayoba, S., & Lekule, F. Effect of Moringa (Moringa oleifera) Inclusion in Cassava Based Diets Fed to Broiler Chickens. International Journal of Poultry Science 9 (4): 363-367, 2010 ISSN 1682-8356. Moringa in the diet of laying hens. The results, therefore, suggest that MOLM could completely replace SSC up to 20% without any detrimental effect in laying chickens. However, for better efficiency 10% inclusion level is optimal and an addition of MOLM above 10% high energy based feeds are required for better utilization. Moringa O. as an anti-inflammatory Moringa O. root showed best effects in acute inflammation and is useful in chronic inflammatory conditions. It showed the ability to inhibit cellular accumulation and fluid exudation when tested on carrageenan-induced oedema in rats. Mahajan, S., et al. Protective Effect of Ethanolic Extract of Seeds of Moringa oleifera Lam. Against Inflammation Associated with Development of Arthritis in Rats. Journal of Immunotoxicology. Published online: 9 Oct 2008 Moringa O. as an insulinotropic Acetone extract of Moringa Oleifera has an insulinotroic action via the KATP-dependent pathway of insulin release. Ojo, O., & Ojo, C. Insulinotropic actions of Moringa oleifera involves the induction of membrane depolarization and enhancement of intracellular calcium concentration. J Exp Integr Med. 2015; 5(1): 36-41. doi: 10.5455/jeim.080115.or.117 Moringa O. as an anti-asthmatic Moringa Oleifera was shown to have a bronchodilating effect comparable to ketotifen fumarate on guinea pigs exposed to histamine aerosol or acetylcholine with a lengthening of pre-convulsion time with pretreatment of Moringa O. showing that the seed kernels anti-inflammatory, antimicrobial and mast cell stabilization effects underlie its anti-asthmatic effects. Mehta, A., & Agrawal, B., Investigation into the mechanism of action of Moringa oleifera for its anti-asthmatic activity. Oriental Pharmacy and Experimental Medicine 8(1):24-31 • March 2008 DOI: 10.3742/OPEM.2008.8.1.024 Moringa Oleifera and cholesterol The hypolipidaemic effect of Moringa O. Was shown in a study that found it increased excretion of faecal cholesterol. Moringa O. and cholesterol and diabetes M. oleifera treatment was effective to improve plasma glucose disposal only in diabetic rats. It had a hypoglycemic effect comparable to administration of 2.5mg/kg-bw of the anti-diabetic drug Glipizide. Increased insulin secretion was no involved in the hypoglycaemic effect. M. oleifera medication can induce better glucose tolerance over time. Rabbits fed a high cholesterol diet which caused caused extensive plaque formation in carotid arteries as well as overall increased cholesterol levels, had a reduction in total cholesterol of around 50% and 75% for carotal artery plaque formation when Moringa O. aqueous leaf extract was added at 100mg/kg-bw with similar results using Moring O. aqueous fruit extract. Result was comparable to the protective effect given by anti-cholesterol drug simvastatin at 5mg/kg-bw. In human hyperlipidemic subjects given 4.6gm dehydrated leaves at a dose of 2 x 550mg tablets twice a day results indicated that the treatment induced a lesser atherogenic lipid profile. Mbikay, M. Therapeutic Potential of Moringa oleifera Leaves in Chronic Hyperglycemia and Dyslipidemia: A Review. Front Pharmacol. 2012; 3: 24. Published online 2012 Mar 1. doi: 10.3389/fphar.2012.00024 Moringa Oleifera and Anticancer, Antibacterial and Hypotensive properties Moringa Oleifera was shown to have rich amounts of a simple sugar, rhamnose as well as glucosinolates and isothiocyanates which reportedly had anticancer, antibacterial and hypotensive activity. Fahey, J. Moringa Oleifera: A Review of the Medical Evidence for its Nutritional, Therapeutic and Prophylactic properties. Part 1. (Vols. Copyright 2005 Jed. W. Fahey, Baltimore, Maryland: Johns Hopkins School of Medicine, Department of Pharmacology and Molecular Sciences, Lewis B. And Dorothy Cullman Cancer Chemoprotection Center, 725 N. Wolfe Street, 406 WBSB, Baltimore, Maryland, USA 21205-2185) Rhodiola protecting cells against H202 damage Rhodiola helps protect cells against h2o2 http://www.sciencedirect.com/science/article/pii/S0891584909003219 Khare, C. Indian Medicinal plants. 2007. Springer: N.Y Leone, A., Spada, A., Battezzati, A., Schiraldi, A., Aristil, J., & Bertoli, S. Cultivation, Genetic, Ethnopharmacology, Phytochemistry and Pharmacology of Moringa oleifera Leaves: An OverviewInt J Mol Sci. 2015 Jun; 16(6): 12791–12835. doi: 10.3390/ijms160612791 Jerri, H., Adolfsen, K., McCullough, L., Velegol, D., & Velegol, S. Antimicrobial sand via adsorption of cationic Moringa oleifera protein. Langmuir. 2012 Jan 31;28(4):2262-8. doi: 10.1021/la2038262. Epub 2011 Dec 22 © 2017 Will Shannon – Pinnacle Encyclopedia of Botanical Pharmacology

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Malaysia is gradually emerging from the worst wave of the pandemic, with the economy expected to be on the recovery path in 2022. - Daily new infections are on the downward trend, largely a result of the country’s high vaccination rates. - A rebound in domestic demand and expanding exports is expected to fuel projected growth of 5.8 percent in 2022. The country’s projected recovery path ahead still faces downside risks from global uncertainties around the pandemic, supply disruptions and diminished macroeconomic support. - Global growth is projected to decelerate to 4.3 percent in 2022 (5.6 percent in 2021). - Headline unemployment rates remain at 4.5 percent for the country but youth unemployment (15-25 age group) remains high at 11 percent. Underemployment similarly remains elevated highlighting structural issues such as skills mismatches. - Possible resurgence in Covid-19 infections in light of new variants could further dampen global and domestic recovery paths. - Rising vulnerability among both households and firms pose further concerns to future recovery. - The fiscal deficit is expected to widen to 6.5 percent in 2021 following an upward revision in spending by 0.6 percent of GDP, while revenue collection slipped downwards by 0.5 percent of GDP. - Higher spending has been facilitated by an increase in the debt ceiling to 65 percent in October 2021, but debt service charges are expected to rise further to 18.4 percent in 2022. Fiscal consolidation will need to be prioritised to ensure effective government spending and revenue collection in the medium-term - The proposed Fiscal Responsibility Act (FRA) in 2022 provides a timely opportunity to establish such a path for consolidation - On the revenue front, new tax measures such as the one-off windfall tax, tax on sugar-sweetened beverages and removal of exemptions on foreign income are expected to provide a small impact. - Rebuilding of fiscal buffers should remain a medium term priority include measures such as a more progressive tax framework and broadening of the tax base. Immediate priorities, however, should focus on continuing existing support measures, strengthening the health system and improving the breadth and depth of social protection systems. - These priorities are immediately crucial as the pandemic has exacerbated the challenges faced by Malaysian households, particularly the poor and vulnerable. - The withdrawal of personal savings and limiting consumption mentioned as the most common coping mechanism during the pandemic. More than half of all households reported lower savings post-pandemic. - Despite the government programs aimed at assisting households during the pandemic, a third of low-income households still reported not being beneficiaries of these programs. - Informal employment is also relatively high at 33 percent, and are more prone to income disruptions, further underscoring the need for better social protection. - Learning outcomes have also been impacted with an estimated 1.3 years of additional learning losses incurred by Malaysian students. - Learning losses exacerbate the existing learning gaps and inequity present among students. To address these compounding concerns, short-term measures are needed to support Malaysian households’ recovery - Continuing existing income relief measures - Introducing targeted wage subsidies, particularly for women and youth - Increasing the coverage and adequacy of social insurance programs - Supporting teachers, schools and district officers with strategies to help students overcome learning difficulties - Creating remedial interventions to support especially disadvantaged students - Assessing the current learning losses and making necessary adjustments to mitigate those losses.

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The following facts were gathered from YATCO to bring you highlights from the previous week. Enjoy, and please feel free to share with colleagues and clients alike. Yachts New to the Market The 150′ 1″ (45.75m) motor yacht CATCHING MOMENTS is just like her name implies, ready to accommodate and make every moment on board a delight for her guests and owners. She was built by Richmond Yachts in 2013 and represents the last and best Richmond yacht ever built with tons of upgrades and improvements. She was added to the YATCO BOSS for sale market last week and is available at $15,000,000 USD with Chris Daves at Denison Yacht Sales – Fort Lauderdale. Located in North Palm Beach, Florida. ARIA.S is a 28.2m (92′ 7″) motor yacht built by Arcadia Yachts. She was added to the YATCO BOSS for sale market last week with Marco Fodale at Fraser Yachts – Monaco and is available for visits in Italy. She features a minimalistic interior by the designer Francesco Guida and she offers her owner and guests the rare opportunity to cruise and enjoy yachting eco-consciously. Listed at $6,224,043 USD (€5,500,000 EUR). The largest yacht to be added to the YATCO BOSS for sale market last week is the steel-hulled 56m (183′ 9″) LADY CANDY. She was built by Benetti in 2013 and is listed for sale with Greg Gheraia from BlackOrange Superyachts Experts at $32,000,000 USD. She is currently located in Kota Kinabalu, Malaysia. Her guests and owner can enjoy her many comforts and she shows in meticulous condition. She has zero-speed stabilizers and features a beach cub, massage room, cinema room and all decks are accessible by a private elevator. IMPETUOUS is a motor yacht built in 1977 by Feadship. She offers a great opportunity to own an 85′ (25.91m) sport fisherman yacht that is ready to cruise. Allow yourself to be impressed by the timeless exterior design by the designer H.W. de Voogt & Zn. She is available at $1,575,000 USD and is listed for sale with Ken Denison and Sidney Ambroise from Denison Yacht Sales. SWEET TUNA is ready to take a new owner on adventures. Fishing, cruising, and enjoying the sea. She is a stunning 92′ (28.04m) sport fisherman built in 2017 by the Viking. She was added to the YATCO BOSS for sale market last week and she is in turnkey condition. Available at $8,750,000 USD with Stephen Moynihan from HMY Yacht Sales – Palm Beach Gardens FL. SWEET TUNA is currently located in North Palm Beach, Florida.

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http://rexperrytrucks.ga/genuine-money-online-slots/

2022-05-18T07:34:53Z

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Crushers Malaysia For Sale Crushers Malaysia For Sale Alibabacom offers 2499 crushers malaysia for sale products About 34 of these are crusher 17 are plastic crushing machines and 1 are other metal amp metallurgy machinery. Jaw crusher is the vital equipment in crushing industry.Detail Roll crusher (roller crusher) is suitable for the fine crushing of the materials with feeding size less than 110mm, and finished particle size 3-30mm.Detail Sand maker is also known as impact crusher or sand making machine.Detail Ball mill is the vital equipment for recrushing after being crushed.Detail Circular vibrating screen is mainly used to screen the dry materials used for metallurgy, coal, ore, etc.Detail Raymond mill is also known as Raymond, Raymond machine.Detail

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DEREK JETER New York Yankees AUTOGRAPHED BASEBALL. Comes In Plastic Display Case. Very Clear Signature See Picture. Comes with a COA Sticker On Ball Heritage Authentication : 45888. The item "DEREK JETER AUTOGRAPHED BASEBALL COA Included Comes In Display Case" is in sale since Tuesday, November 23, 2021. This item is in the category "Sports Mem, Cards & Fan Shop\Autographs-Original\Baseball-MLB\Balls". The seller is "polemeni" and is located in Du Bois, Pennsylvania.This item can be shipped to United States, Canada, United Kingdom, Denmark, Romania, Slovakia, Bulgaria, Czech republic, Finland, Hungary, Latvia, Lithuania, Malta, Estonia, Australia, Greece, Portugal, Cyprus, Slovenia, Japan, China, Sweden, South Korea, Indonesia, Taiwan, South africa, Thailand, Belgium, France, Hong Kong, Ireland, Netherlands, Poland, Spain, Italy, Germany, Austria, Bahamas, Israel, Mexico, New Zealand, Singapore, Switzerland, Norway, Saudi arabia, Ukraine, United arab emirates, Qatar, Kuwait, Bahrain, Croatia, Malaysia, Brazil, Chile, Colombia, Costa rica, Dominican republic, Panama, Trinidad and tobago, Guatemala, El salvador, Honduras, Jamaica, Antigua and barbuda, Aruba, Belize, Dominica, Grenada, Saint kitts and nevis, Saint lucia, Montserrat, Turks and caicos islands, Barbados, Bangladesh, Bermuda, Brunei darussalam, Bolivia, Ecuador, Egypt, French guiana, Guernsey, Gibraltar, Guadeloupe, Iceland, Jersey, Jordan, Cambodia, Cayman islands, Liechtenstein, Sri lanka, Luxembourg, Monaco, Macao, Martinique, Maldives, Nicaragua, Oman, Peru, Pakistan, Paraguay, Reunion, Viet nam, Uruguay, Russian federation.

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2022-05-18T06:22:51Z

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The Latest survey report on Electric Vehicle Charging Docks Market has witnessed continuous growth in the last few years and is projected to grow even further during the forecast period of 2022-2028. The market Study is segmented by key region that is accelerating the marketization. The analysts of the study have garnered extensive research methodologies and data sources (i.e Secondary & Primary Sources) in order to generate collective and useful information that delivers latest market undercurrents and industry trends. The list of players that are profiled in the study includes ChargePoint, Tesla Motors, ABB, Siemens AG, Schneider Electric, BP Chargemaster, DBT, Leviton Manufacturing, Eaton Corporation, SemaConnect, AeroVironment, EVBox, ClipperCreek, Webasto, RWE, Newmotion (Shell), DEKRA CERTIFICATION, Evgo, Total, Blink, POTEVIO, CLOUESS, Suzhou Industrial Park Heshun Electric, ATC, Efacec, Ralphs Lane & Zhejiamg Wanma etc. Avail Free Sample Pages PDF (Including Full TOC, Table & Figures) @ https://www.htfmarketreport.com/sample-report/3862855-electric-vehicle-charging-docks-market-1 The key points of the report: 1.The Electric Vehicle Charging Docks Market report provides a basic overview of the industry including its definition, applications and manufacturing technology. 2.The Electric Vehicle Charging Docks Market report explores the international and Chinese major industry players in detail. 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You can also get individual chapter wise section or region wise report version like North America, Europe or Asia. HTF Market Intelligence consulting is uniquely positioned empower and inspire with research and consulting services to empower businesses with growth strategies, by offering services with extraordinary depth and breadth of thought leadership, research, tools, events and experience that assist in decision making. Craig Francis (PR & Marketing Manager) HTF Market Intelligence Consulting Private Limited Unit No. 429, Parsonage Road Edison, NJ New Jersey USA – 08837 Phone: +1 (206) 317 1218

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2022-05-18T06:32:41Z

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Date posted: April 9, 2018 Afghans have collected 1 million signatures to prevent the transfer of Turkish schools established by businessmen and operated by educators allegedly affiliated with the Gülen movement for decades in Afghanistan to the Maarif Foundation, which was established by the government of Turkish President Recep Tayyip Erdoğan to seize Gülen movement-affiliated schools abroad. The top agenda of Turkish Prime Minister Binali Yıldırım, who made an official visit to Afghanistan on the weekend, was to assure the transfer of Turkish schools to the Maarif Foundation. Although a protocol was signed on February 26, 2018 for the transfer of these schools to the Foundation, this protocol could not be implemented by the Afghan administration so far. It was reported by Turkish media that PM Yıldırım has tried to put pressure on Kabul administration with the recent visit to assure the implementation of the signed protocol. Prime Minister Yıldırım said during his joint press conference with his Afghan counterpart Abdullah Abdullah in Kabul that “I appreciate your decision to transfer these schools to the Maarif Foundation, which we have established as a state. Our teachers have come and they are now waiting. There is no obstacle ahead for the transfer process to be put into practice. We expect the continuation of your support on this issue.” Yıldırım also claimed that there is no political motive behind the decision to hand over Afghan-Turk schools to the Turkish government. He claimed that the decision has been taken to improve the services and develop these schools in Afghanistan. Defining the decision in favor of students, Abdullah said that the agreement has been signed with Turkish Maarif Foundation so the teachers that coming from Turkey would be able to take responsibility in the schools. He said they have also agreed that joint supervision should take place between Afghan Ministry of Education and Maarif Foundation. However, the parents of the Afghan students who have taken quality education at the schools operated by Afghan-Turk Çağ Educational NGO (ATCE) reacted against the demand voiced by Turkish Prime Minister Yıldırım. The Afghan parents, who have collected 1 million signatures to prevent transfers of these schools to Erdoğan’s Maarif Foundation, have stated that “The Turkish government must treat the Afghan nation with respect.” ATCE has been serving to the Afghan children for 23 years with 12 high schools, 4 primary schools, 4 preparation courses, dormitories and laboratories across Afghanistan. However, Turkish government’s massive post-coup witch hunt campaign against the alleged members of the Gülen movement following the controversial coup attempt on July 15, 2016 has also targeted the Turkish teachers abroad. The AKP government has requested the countries which are under its influence to close these schools or to transfer them to the Maarif Foundation. The Turkish government has also not hide that it makes plans to abduct the teachers who are working for these schools abroad. The Turkish government has become successful to abduct some teachers in Pakistan, Malaysia, Gabon, and Kosovo so far. Mohammad Yusuf Pashtun, head of Afghan-Turk Parents’ Association has said that they will not allow any country or organization to use its support for Afghanistan’s education as a pretext to interfere in Afghanistan’s domestic affairs and pursue its own interests. “We will not give support to any institution and association of Turkey to intervene into the domestic affairs of our country and to carry out intelligence related purposes under the guise of education by violating the country’s constitution and the rules of the international law,” he said. Meanwhile, Ahmad Fawad Haidari, the deputy director of Afghan-Turk schools, has also said that the Afghan government’s decision to hand over the management of the schools to the Turkey’s Maarif Foundation was against the Afghan law and they will continue to rise their objections in this regard. Three Turkish teachers, Mesut Vardak, Önder Akkuşçu and Yılmaz Aytan, one Afghan teacher and a Turkish businessman, Sami Yavuz, were detained by Afghan intelligence officials in December 2017 on the request of Turkish government over their alleged links to the Gülen movement as Afghan President Ashraf Ghani was on his way to İstanbul to attend the Organization of Islamic Cooperation (OIC) Summit on Jerusalem crisis. Their deportation to Turkey could be prevented with the efforts of the UN at the last moment. Because of this background, the visit by Turkish PM Yıldırım together with his cabinet’s 5 ministers and deputies to Afghanistan has created a severe uneasy among the Afghan students’ parents. Holding a press conference in Kabul on the occasion of PM Yıldırım’s visit to Afghanistan, Pashtun has stated that “If Turkish Prime Minster’s visit to Kabul is for damaging the school system, as the Parents’ Association we condemn the Turkish Prime Minister for this visit. We consider this visit is in contradiction to the interests of the Afghan nation and the historical ties between the people of the two countries.” While underlining the fact that they are against the Maarif Foundation, Pashtun has also stated that “In order to support the present school administration and to object the transfers of these schools to Turkish government, as students and parents we have collected 1 million signatures. The government officials need to consider the thoughts and the decisions of the Afghan nation.” Reading a 7-point declaration, Pashtun stated that “The decisions taken by Afghan and Turkish governments about the fate of Afghan-Turk Schools are against the Constitution. We ask the government authorities to reject these decisions immediately and to make it clear to the public.” Speaking to the Afghan government, Pashtun said, “Do not continue to follow illegal policies for the sake of fulfilling the purposes of the foreigners. If you continue to do the practices contrary to the Constitution, you will find the serious decisions of the Parents’ Association and all the responsibilities of these decisions will belong to the government. Parents’ Association will always support the Constitution of Afghanistan.” “If a prime minister comes here to take only a few schools, we will be even more determined to protect those schools,” said Fazıl Ahmad Manawi, the Vice-President of the Parents’ Association and added that “A prime minister is coming this country to take over schools which are mostly Afghans. Only a few Turks work in these schools and most of the schools are affiliated to Afghans. If a few Turkish teachers are so important to a prime minister, then our commitment to our future will be even greater.” “We will not allow those who want to harm the future of our children and their education,” Manawi said and continued: “We will not allow any foreign country to play with the future of our children. I have always thought of a formula for solving this problem. When I heard the words of the Maarif Foundation’s spokesperson, I found the solution. The Maarif Foundation claims that they will double the number of Afghan-Turk schools. So they were going to make the number of Turkish schools 24. Then the issue is resolved. You will build 12 schools first, then take over these present schools. You could not find a more logical, more peaceful and more effective solution than this. We promise, if the Maarif Foundation will build 12 more schools, we will sign for the transfer of the remaining 12 schools.” Sharing a dialogue between him and his daughter, Manawi said that “Last night there was news about schools in TVs. My daughter asked me a question: ‘Dad, where do they go if they take Turkish teachers out of here?’ I said, ‘We will not allow this. But if we can not afford this, the teachers go to other countries.’ My daughter asked again: ‘Does not Turkish government arrest them in those countries?’ I said, ‘No, the rule of laws dominates and there are sovereign governments in those countries.’” “However, we have no law, no sovereign government in our country. Such a weak government which bow before the illegitimate demands of foreign countries and opposes its own nation’s will would never be respected. A (Turkish) government, which does not show compassion and pity for the students who are studying here, is pitiable to no one else. However in these debates, our government is more responsible than the Turkish government. Why does the Afghan government submit to the illogical, illegal and illegitimate desire of a foreign country? ” Manevi has also stated that “The Turkish government should respect the will of the Afghan nation. The seizure of these schools is one of those disrespectful acts.” Reacting to the Maarif Foundation, Manawi has also said that “The Maarif Foundation’s spokesperson made an arrogant and immoral statement by saying that ‘let us see what we will do.’ Sorry guy, our country is not a laboratory… These schools have been serving in Afghanistan for 23 years and they are respected by everyone and we are all here to protect the interests of our nation and our country.” Abdulshukur Dadres, another vice president of the Parents’ Association of the Afghan-Turk Schools, also reacted to the AKP government and stated that “Turkey’s President Erdoğan had made a commitment to Afghan people years ago. He had said that ‘We will build a university, we will restore Mevlana’s birthplace, we will build a hospital,’ but none of these promises were delivered by him. But, I do not know why, he began to show an intense interest in Afghanistan after the coup attempt in Turkey. Does Turkish government want to serve these schools or they just want to take the Turkish teachers at these schools? If they want to give support to Afghan schools then here they are. No, we understand that they have no intention of helping to Afghan people.” Dadres has also criticized the protocol signed on February 26 and argued that this protocol can not be implemented. “It has been 43 days since the deal was signed and the Turkish government has been advertising every day by saying that ‘we have taken over the schools.’ Who took over these schools? Everyone knows who owns these schools. Believe me it is very embarrassing, very regretful and very bad. It’s been almost a month and a half, but they have not managed to get the schools yet. The Council of Ministers also endorsed this agreement. Unfortunately, nobody has asked what do these parents, what do these people say and what do they want.” Dadres continued to say that “Then, Turkey’s Prime Minister visiting here today. The biggest goal of this visit is to take over these schools. Never! Any intervention into the Afghanistan’s cultural and educational sphere will have a heavy price. Maybe you will pick up these schools, but nobody can get in here. They could hear what I say. We had a meeting with a senior government official recently. We have showed him the same stance and our stance will continue. We want the issue to be solved within the framework of the law. We do not accept anything illegal.” Source: Stockholm Center for Freedom , April 9, 2018

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2022-05-18T06:38:03Z

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Abstract: On 11th April, the Victoria International School Rugby Final is to kick off. As the official sponsor of the game, Airwheel Malaysia distributor is going to display all lines of intelligent electric scooter. The long-awaited Malaysian Rugby Final is due to kick off in Victoria International School on 11th April. This game is anticipated to gather a great number of audiences and dozens of media groups. Airwheel Malaysia distributor planned to fund this long-expected game, intending to provide five models of Airwheel's self-balancing unicycle as prizes for a lucky drawing. During the rugby final, Airwheel Malaysia distributor is set to demonstrate various lines of electric scooter, including the latest intelligent self-balancing scooter. Through this demonstration in the rugby final, Airwheel attempts to offer players, students and audiences an opportunity to get a better understanding of Airwheel's scooters as well as gain a fresh riding experience. Airwheel is a world-renowned scooter-maker established in 2013. The products by Airwheel, namely the X-series, Q-series and S-series, have made a splash in the global market, especially Euro-American market. According to feedbacks from Airwheel distributors, the Southeast Asian market is an emerging market full of tremendous potentials. Considering this fact, Airwheel management team attaches great importance to this emerging market. In fact, Airwheel has grasped every opportunity to attend major events in Southeast Asia lately. In Langkawi International Maritime and Aerospace Exhibition held in Malaysia this month, Airwheel electric unicycles and intelligent self-balancing scooters became the hot topic. It is widely estimated that Airwheel would steal the limelight in the upcoming rugby final. The surging popularity of Airwheel electric self-balancing scooter worldwide owes largely to their competitive characteristics. The primary characteristic is safety. The self-balancing mechanism and gyroscope system ensure the balance in riding. In addition, the built-in alert system serves to prevent riders from falling over. The eco-friendly feature is also one of the main draws. The introduction of the lithium battery core eliminates emissions, catering to the current low-carbon trend. In eyes of youngsters, the exquisite exterior design also plays an indispensable role. The streamlined and sleek contour has been mesmerising those trendsetters. On 11th April, Airwheel intelligent electric scooter are expected to capture considerable attention from local audience and media groups.

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2022-05-18T05:43:16Z

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The information contained in this website is for general guidance on matters of interest only. The application and impact of laws can vary widely based on the specific facts involved. Given the changing nature of laws, rules and regulations, and the inherent dangers of electronic communication, delays, omissions or inaccuracies in information contained in this website may arise. Given above, the information in this website is provided with the understanding that the authors and publishers are not herein engaged in rendering legal, accounting, tax, or other professional advice and services. As such, the information in this website should not be used as a substitute for consultation with professional accounting, tax, legal or other advisers. Prior to taking any decision or any action, you should at all times consult a professional adviser in the relevant field. While we have made every attempt to ensure that the information contained in this website has been obtained from reliable sources, Malaysia Grand Prix cannot and will not be held responsible for any errors or omissions, or for the results obtained from the use of this information. All information in this website is provided on "as is"-basis, with no guarantee of completeness, accuracy, timeliness or of the results obtained from the use of this information. In addition, no warranty of any kind, express or implied, is provided, including, but not limited to warranties of performance, merchantability and fitness for any one particular purpose. In no event will Malaysia Grand Prix or any of its related companies, corporations, agents, employees or consultants be held liable to anyone else for any decision or action taken in reliance on the information in this website, or for any consequential, particular or similar damages, even if advised of the possibility of such damages. Certain links in this website connect to other websites maintained by third parties over whom Malaysia Grand Prix has no control. Malaysia Grand Prix makes no representations as to the accuracy or any other aspect of information contained in any of these third party website. Malaysia Grand Prix reserves the right to make any changes to above notices without prior notice. This notice relates specifically to the interactive forms currently present on this website. Malaysia Grand Prix will only use the data collected from these forms to assist and complete enquiries. The data thus gathered will never be used for marketing purposes and will never be passed on to any other parties.

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Here are the top 10 Facebook marketing tips for small businesses in Malaysia to help you increase visibility, boost sales and improve your overall branding strategy. Malaysians are ‘addicted’ to Facebook, and that’s a fact. If you are a business owner, you should be leveraging Facebook marketing as much as possible to increase brand visibility and improve sales revenue. As Facebook is constantly evolving, it can be tricky for small business owners in Malaysia to know where to start. That’s why this article is all about! You will find the top Facebook marketing tips for small business in Malaysia so that you can start promoting your products and services to a wider set of audience. And if you want to get more free Facebook tips (or social media tips) delivered directly to you weekly, click here to sign up for our newsletter. Our newsletter goes out every Monday at 9 am! Alright, you may know about this (or maybe not), but you should always have a Facebook Business Page. Facebook has over 1 billion users, and your potential customers are using the social media platform. Plus, having a business page is one of the best free ways when it comes to Facebook marketing. Are you portraying the right information to the visitors who are visiting your Facebook Page? As a matter of fact, most of the business owners are guilty of not spending enough time and putting effort into writing the descriptions. Your visitors will only spend around 15 seconds on your Facebook Page. So, make sure they can find the right information and always use Call To Actions (CTA) to encourage them to contact you. Do you know that Facebook cover photo is insanely important (and overly overlooked)? Here are some tips to have great Facebook cover photos: Your fans will only engage with your content if they find the content engaging. With the amount of content we are bombarded with on a daily basis, we should only share content that matters most to your audience. In this case, make sure that you are sharing highly actionable tips and tricks. More importantly, you should always do weekly analytics on the type of content that gets you the most attention from the fans. Instead of sharing a wall of text, why don’t reduce the text and replace with engaging media? Human processes images faster than words. Therefore, you should always integrate different images, audio, and video into your overall Facebook marketing strategy. Do you know that using Facebook apps are extremely important especially for small businesses? For starters, the usage of Facebook apps will help to ease your burden in marketing. At Marketing Lancers, we are using Aweber as our email marketing solution, and instead of coding it manually on our Facebook Page, we use Aweber app to integrate with our Facebook Page. The results? The entire integration takes us a mere 10 seconds to complete. There are many other Facebook apps that you can use such as: Facebook ads are best when you want to reach a specific audience within a short period, or when you want to boost visibility 100x more than your competitors. Facebook advertisement can be time-consuming and if you need a guide for that, fill up this form, and we’ll be happy to send over a guide on the Facebook advertisement. Small business should invest at least $100 a month on Facebook marketing to boost their visibility and sales. One of the most powerful Facebook marketing tips for small business in Malaysia is to make it easy for others to locate you. This is extremely important especially when you are running a brick and mortar business. Do you know that we often use Facebook to search for businesses instead of using Google? Several simple setups you can do on your Facebook Page to be more visible are: Facebook is a powerful social media platform and businesses can go fairly wrong when they use Facebook solely for marketing purposes. An important Facebook marketing tips for small business in Malaysia is infused fun and business under one roof. At the same time, don't use Facebook marketing entirely about your business. Instead, use Facebook posts (or advertisements) to solve the challenges your fans are facing. This means that business owners should always come up with a content marketing strategy that provides valuable knowledge to your audience, while avoid being overly promotional. As Facebook users ourselves, we hate seeing too many self-promotional materials and we often dig in for informative posts instead! At Marketing Lancers, we are often asked to give actionable Facebook marketing tips for small business in Malaysia. Our message is always the same, “Don’t be afraid to try on something new.” As business owners and entrepreneurs, you should always try to think out of the box and head to uncharted waters. Here are some examples of trying something new on Facebook: At the end of the day, you want to project fun and yet informative information which your fans are going to appreciate it. I hope you enjoyed the Facebook marketing tips for small business in Malaysia that are shared in this article. Tell us what you think, which is your favorite Facebook marketing tips and we would appreciate if you will share the information with your friends!

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An automated screening kiosk developed by a Missouri University of Science and Technology researcher could alleviate concerns about safety and wait time at U.S. airports and border crossings. Dr. Nathan Twyman, assistant professor of business and information technology at Missouri S&T, has been developing a next-generation automated screening kiosk since he was a Ph.D. student at the University of Arizona. His screening kiosk uses an algorithm of “yes” or “no” questions delivered by a computer-generated avatar to quickly and efficiently assess the potential threats passengers may pose to others. Twyman says the screening can be completed in less than four minutes with a 90 percent success rate. The assessment’s speed and success rate are better than security at most airports in the United States, Twyman says. In fact, an internal investigation by the Transportation Security Administration in 2015 found that TSA agents failed to identify explosives and banned weapons 95 percent of the time. The investigation was carried out by undercover Homeland Security “Red Teams” that posed as passengers. In 67 of 70 instances, the investigators were able to get through security with mock explosives or banned weapons without being detected. Typically, when travelers enter the United States on an international flight, they must go through a U.S. Customs and Border Protection (CBP) area where a CBP officer screens them. Depending on their answers, the officer might ask them one question, or a handful of questions. The process can be alarmingly subjective, Twyman says. Twyman’s automated screening kiosk eliminates this subjectivity. “We don’t want random,” says Twyman. “(The kiosk) is not profiling. It’s not pulling you aside because of your religion. And on top of that, it’s not going to get tired. It’s not going to make mistakes because it’s ready to go on a break. It’s a lot better than a human solution. Humans are really bad at risk assessment, as it turns out.” Twyman’s screening kiosk asks a series of basic “yes” or “no” questions and measures the user’s responses through a variety of techniques. An infrared camera scans a subject’s eye movement and pupil dilation; a video camera captures natural reactions to feeling threatened, such as body and facial rigidity; and a microphone records vocal data, listening for changes in pitch that accompany uncertainty. “This (screening kiosk) measures various psychophysiological responses and tries to make some sort of a risk assessment outcome,” says Twyman. “It’s an automated risk assessment, instead of a seat-of-your-pants risk assessment. There’s a controlled, structured process for it. It gives (CBP officers) some more hope that they can pick out who they need to pick out instead of patting down grandma at the airport.” When users approach the kiosk, they are greeted by a computer-generated image of a young man with black hair. The talking head gets right to the point with questions such as, “Have you ever been arrested?” and “Have you moved in the past five years?” When the avatar is done with its questions, the machine reports its findings question-by-question to the CBP officers or border patrol agents on duty. Risk is determined on a color-coded basis, with green being of low risk, yellow being of moderate risk and red being of high risk. Twyman prefers this straightforward approach to asking questions to other automated security systems, which he says can be more conversational. “I made the kiosk as scientifically controlled as possible,” he says. “(The avatar) doesn’t care if it’s your friend or not. It isn’t interested in asking you how your day went and trying to pretend that it’s human. This doesn’t pretend that it’s human. It follows the most scientifically accepted approach to human risk assessment. It gives you a really solid baseline to work with. When someone’s telling you the truth, compare that to when they’re lying. Without that baseline, it’s hard to really gauge people. For the kiosk, that baseline is very important.” Twyman has conducted field studies at a border crossing in Nogales, Arizona, a field experiment at a TSA Systems Integration Facility in Washington, D.C., and a field experiment in Apeldoorn, Netherlands, using European Union border guards. Now, he’s hoping to implement the kiosks in real-world situations. “We’ve been all over the world doing these various tests,” he says. “We’ve got good data, but we need to actually be able to implement it in a real-world scenario. It’s hard to sell it as the perfect solution if you don’t have the real-world data.” Twyman’s research group is in talks with the government of Singapore to implement the kiosks at the border crossing between the relatively large country of Malaysia and the geographically small city-state of Singapore situated on Malaysia’s southeastern-most corner. “We’re trying to get it out in the field, such as the Singapore-Malaysia border. Places we can essentially do a test evaluation at a real border,” says Twyman. “For them, speed is crucial.” According to the Malaysian government’s 2015 immigration data, more than 250,000 Malaysians cross the country’s border into Singapore twice daily for work. “That’s a lot of people to screen,” says Twyman. “They need to be able to pick out the needle in the haystack without talking to every single individual. A bank of kiosks that can process a number of people all at once and set aside only a few people for more in-depth screening could be a really big benefit to them.” Twyman has received numerous grants from the National Science Foundation for his research. His most recent journal article associated with the research, “Robustness of Multiple Indicators in Automated Screening Systems for Deception Detection,” was published in the April 2016 issue of the Journal of Management Information Systems.

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https://news.mst.edu/2017/07/automated-security-kiosk-could-alleviate-travel-border-woes/

2022-05-18T07:37:53Z

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In a time of perpetual 2-pax gatherings (unless of course you are a Bloomberg delegate), Maya Gallery’s latest exhibition, Rewang, remembers the festivities of yore with wistfulness. Organised by Angkatan Pelukis Aneka Daya (APAD, or Association of Artists of Various Resources), the exhibition features works by 18 Malay artists from an open call that invites artists to respond to theme “Rewang” – the act of coming together as a community to prepare for festivities such as a weddings and religious ceremonies. There’s a smorgasbord of work to see here, from veteran founding members of this 59-year-old institution, Pak Idris Ali, as well as promising young artists such as Rusydan Norr. We were particularly taken with young artist Rusydan Norr’s curious explorations with chlorophyll printing to imprint images from his parents’ wedding onto betel leaves. Once commonly used for gift exchanges between bride and groom in traditional Malay wedding ceremonies, the betel leaf has faded in symbolic significance over time. Likewise, these imprints eventually fade with exposure to light, marking the artist’s commentary on historical traditions that evolve or disappear with time: Works in watercolour and acrylic that we found to be delightful in their technical accomplishment, providing moments of respite in their depictions of nature: On view are also sculptural works by Noor Rahman and Khairul Faizin, which while ambitious in construction, felt unnecessarily didactic in their presentation of moral messages: Check out this show in person before it closes on 5 November 2021! More details here: https://www.facebook.com/apad.sg Feature image: (from left) Artist Rusydan Norr, artist-gallerist Jeffrey Wandly, artist-gallerist Masturah Sha’ari, artist Saiman Ismail, artist-organiser (and present APAD President) Fajrina Razak.

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2022-05-18T06:56:29Z

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Aung San Suu Kyi made a triumphant return to India, the land of a chunk of her childhood and at one point an intellectual source for the Burmese nationalist movement that her father spearheaded. But her visit was also a subtle reminder of how far India’s influence in Myanmar has dwindled and how much work New Delhi must do to restore it to even a fraction of what it once was. When Burma became independent, India’s influence was overwhelming. The British had opened Burma’s doors to hundreds of thousands of Indian settlers. The Indian nationalist movement inspired young Burmese like Aung San Suu Kyi’s father. A branch of my own family settled there, exporting teak to Calcutta. I remember as a youngster having a grand-uncle who still spoke Burmese. But Indians were also resented because of their association with British rule and their control of large sections of the economy. The derogatory phrase for a Burmese foreigner is “Indian” — thus Aung San Suu Kyi, who married a white Briton, was denounced by some military officers as “that woman with her Indian husband.” So it was not a complete surprise that a xenophobic military regime drove out most of the Indian population, leaving behind a largely impoverished Indian diaspora of several hundred thousand. This in effect marked the end of the colonial period of Indian influence in Myanmar. The Indian population was expunged. The economic relationship broken off. Both countries retired into a form of isolationism until the 1980s. India aroused itself from its reverie when the military junta overturned Aung San Suu Kyi’s first election victory. Rajiv Gandhi was a fervent supporter of her democracy movement, reportedly even to the point of providing arms to some of the students who fled to India. Prime Minister P.V. Narasimha Rao reversed the policy for hard-nosed reasons: the Kashmir insurgency was peaking, forcing him to denude the Northeast of paramilitary units, and to save Nagaland from being overrun, India had to come to terms with the Myanmar military. The policy worked well, but Aung San Suu Kyi and her expectations regarding India had to be sacrificed. I would argue that, for all the talk of the closeness in relations between the two countries that one hears in Delhi, India has the following problems with its present standing in Myanmar: One, among the pro-democracy activists, there is a sense of betrayal when it comes to India. They can hardly be expected to be impressed with the realpolitik explanation — and it is not as if the Indian government has done much to explain this to the wider public. Two, India declined to support Western sanctions, but trade and investment nonetheless declined dramatically during the past few decades. A policy of de facto sanctions that one can now see in India’s economic ties with Iran. Forget about vying with China, India has about as much economic influence in Myanmar today as Singapore and Malaysia. It trails not only China, but also Thailand. And watch the US and Japan ratchet up their presence in the coming years. Three, India has a good relationship with the military. But it is not as close as the one that the generals have with China. China provided weapons and much more investment. It is probably fair to say the military see New Delhi as more benign than Beijing and more trustworthy than Washington. However, that will count for only so much in the new Myanmar. Fourth, India has little or no standing with the ethnic groups. India joined forces with Myanmar to beat the Nagas into submission. And many Chins and a few students have taken up residence in India. Otherwise, however, India did little to cultivate these exile groups. Like the Burmese pro-democracy activists, these groups look to the West as their international benefactors and guardians. Finally, India has not burned its bridges with any group but it does not have any really Indophilic group in Yangon today. India is seen as benign, neighborly and somewhat ineffectual. The last has been fed not merely by India’s past flip flops but also the terrible record India has when it comes to finishing the various dams, roads and ports it has promised to build in Myanmar. None, in fact, are completed and none are on schedule. “We have a credibility problem in Myanmar,” admit Indian diplomats who served there. None of this is irreversible. However, there should be no euphoria about India’s standing in Myanmar based on the colonial or even ancient Buddhist past. More importantly, India needs to recognize that with China, the West and the Southeast Asian nations all jockeying for influence as Myanmar opens up, it should not expect to get a footprint by working on its own. If the purpose of this engagement is to limit Chinese influence, then India should look to sign up with other like-minded nations in such efforts. New Delhi has much to catch up with in Myanmar and it should accept whichever helping hand it can find. Copyright © 2012 the Hindustan Times.

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Panel Material: SUS304 Stainless Steel. Hand Shower: Engineering Grade Plastics ABS. Shower Hose: 59 long stainless steel. Functions: 5 Modes (Rainfall, Waterfall, Body Massage Spray, Hand Shower, Water Spout).LED Power:Water Flow, No Battery Need. Shower Panel Length: 111 cm (43.7). Shower Panel Length: 47 cm (18.5). Shower Panel Width: 20 cm (8). LED power: Water Flow, Not electric. Waterfall and rainfall 2 function can only work separately. Led light powered by water flow, Temperature display powered by flow. We do our best to send out your order as soon as possible. Our priority is to satisfy you! This item is in the category "Home, Furniture & DIY\Bath\Showers, Baths & Parts\Shower Heads & Combos". The seller is "lantehome" and is located in this country: GB. This item can be shipped to United Kingdom, Antigua and Barbuda, Austria, Belgium, Bulgaria, Croatia, Republic of, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, United States, Bahrain, Canada, Brazil, Japan, New Zealand, Israel, Hong Kong, Norway, Indonesia, Malaysia, Mexico, Singapore, Korea, South, Switzerland, Taiwan, Thailand, Bangladesh, Belize, Bermuda, Bolivia, Barbados, Brunei Darussalam, Cayman Islands, Dominica, Ecuador, Egypt, Guernsey, Gibraltar, Guadeloupe, Grenada, French Guiana, Iceland, Jersey, Jordan, Cambodia, Saint Kitts-Nevis, Saint Lucia, Liechtenstein, Sri Lanka, Macau, Monaco, Maldives, Montserrat, Martinique, Nicaragua, Oman, Pakistan, Peru, Paraguay, Reunion, Turks and Caicos Islands, Aruba, Saudi Arabia, South Africa, United Arab Emirates, Chile, Bahamas, Colombia, Costa Rica, Dominican Republic, Guatemala, Honduras, Jamaica, Kuwait, Panama, Philippines, Qatar, El Salvador, Trinidad and Tobago, Uruguay, Vietnam.

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barite production for malaysia barite production for malaysia 2012 malaysia barite Live Chat barite production for malaysia 2016 process crusher on,. Barite (BARIUM) Barite is used in the production of wallpaper and asbestos goods as well . Sell: Barite, Malaysia Kedah Importers / Exporters Turkey... Mediterranean mining and construction Marketplace designed for Mediterranean traders Italy, Spain, France Turkey exporters, Portugal, Greece and Cyprus importers. Bauxite: Malaysia's sudden mining boom turns into a headache The Washington Post | February 01, 2016 22:16 +08 Malaysia's bauxite industry has left many residents complain of pollution. Barite Mineral Grinding Plant Mining Processing,barite mill for sale . barite mining companies; malaysia barite . Get Price And Support Online; Barite milling operation ,barite milling process,barite milling machine barite milling machinery maintenance company in malaysia barite milling machinery maintenance company in malaysia,if . Barite Crusher in Malaysia Malaysia Ore CrsuherBarite Crusher in Malaysia Barite Crusher in Malaysia If you re planning to buy Malaysia s Barite Crusher or looking into Malaysia Barite Crusher you should know about Xuanshi Machinery It s the best mining crushing equipment Manufacturers and it can help make your Barite ... No representatives from the Land and Mines Department (PTG), or state government were present to brief us on the latest development," he said yesterday. Nin Chin Wan, 64, said people living in the area had been experiencing the side effects caused by the mining activities before the moratorium. Oct 11, 2019· Technical experience from exploration, mining and processing of industrial minerals through to marketing. Handson experience in international logistics for industrial minerals, a unique and demanding business low value, intermediate quantities (FCLs and small bulk), nonhazardous, geographically remote locations GPU Mining Malaysia Puchong Rated 5 based on 6 Reviews "Trusted and instant, every promise delivered and good services provided. Ordered 4 machines... Malaysia, with bauxite mining one of those in the metallic mineral The 18,000 ha area in Kuantan, Pahang is heavily mined for bauxite (found 1 m or 2 m below the soil layer) and this area is occupied with basalt composed of Al From my experience admining one of the Bitcoin Malaysia FB pages (here; join for latest news and updates), seems like many people like to promote unsafe bitcoin investment opportunities. So here's a FAQ about everything you should know about Bitcoin in Malaysia, as a newbie. This is kept fairly jargon free. Versi Malay yang ditulis oleh ... barite minerals company in india Crusher Price,Jaw mines in india. Barite is the most common mineral of barium, produced in epithermal veins, . Jan 22, 2016· Bauxite in Malaysia: The environmental cost of mining Bauxite mining has become a controversial political issue in Malaysia. As the government implements a temporary ban on extracting the aluminium ore, BBC SouthEast Asia correspondent Jonathan Head visits the mostaffected area. We're the largest Bitcoin Mining Machine Supply Supplier in Malaysia, We also helping clients setup bitcoin, litecoin, dashcoin mining farm in Malaysia. We Supply High Quality Bitcoin Miner Antminer S9, Antminer L3 D3 Antminer with Bitmain PSU. Jan 19, 2016· Malaysia has a long history of mining, especially tin, but until very recently it scarcely registered on global markets as a source of bauxite. That changed suddenly in January 2014, when, in . The Malaysian Chamber of Mines was incorporated on 10 December 1914 under the Federated Malay States Chamber of Mines Incorporated Enactment of 1914, which is now known as the Malaysian Chamber of Mines Incorporation Act 1914. It is the only Chamber in the country to have been established by an Act of Parliament. Jan 26, 2016· KUALA LUMPUR (BLOOMBERG) Bauxite mining in Malaysia went on a tear after neighboring Indonesia banned exports, transforming an industry that .

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If, as rumored in Kuala Lumpur, Prime Minister Najib Razak intends to sack another seven United Malays National Organization leaders from the party, he is taking a daring gamble. They include Kedah Chief Minister Mukhriz Mahathir and former Deputy Prime Minister Muhyiddin Yassin. But both Mukhriz, the son of former Prime Minister Mahathir Mohamad, and Muhyiddin hail from the Malay heartland, UMNO strongholds whose support he needs to remain in power. Officials in Johor, where UMNO was born in the 1950s, have already warned that Najib’s dismissal of Muhyiddin as deputy prime minister would wreck the party’s southern power base in 2018. “He is trying to surgically remove all opposition from the party,” said a longtime political observer in Kuala Lumpur. He and other observers speculated that the prime minister’s wife, Rosmah Mansor, is behind the drive to rid the party of figures questioning Najib’s stewardship of the disastrously managed 1Malaysia Development Bhd., although there is no particular proof of that. Najib has already fired Attorney General Abdul Gani Patail, who was said to be preparing charges against him, as well as the head of the police special branch unit and sent two top officials of the Malaysian Anti-Corruption Commission on “vacation.” Officials have also ordered the arrest and questioning of a half-dozen MACC officials on suspicion they were leaking details of the case against the prime minister. A parliamentary investigation has been halted as well as the MACC probe. But while he has gone to extraordinary effort to contain the scandal, it has spread well beyond Malaysia’s borders, with Swiss authorities saying on September 2 that they had frozen funds in Swiss banks amid a probe into people linked to 1MDB, on suspicion of corruption and money laundering. Singapore has already frozen funds despite a private plea from Najib, who reportedly flew to the lion city in August. The entire country was already deeply embarrassed this week by a massive rally that drew tens of thousands of protesters -- one of whom was former PM Mahathir, who is now being investigated for criminal defamation concerning his remarks at the Bersih 4.0 demonstration over the weekend and calling for Najib’s resignation. In addition, Transparency International President Jose Ugaz and 1,000 delegates to the 16th International Anti-Corruption Conference at the government center Putrajaya called attention to corruption allegations involving a US$680 million “donation” to Najib Razak’s personal banking accounts – who paid the money, why and what happened to it. Najib has not come up with any convincing explanation for the funds, deposited in his account in March of 2013. The premier’s peril over the threatened new round of firing stems from the fact that by and large, all of the officials he has sacked are in Putrajaya, the seat of government. Najib has been able to keep the Malay heartland behind him by alleging foreign plots, ethnic Chinese attempts to curb Malay political power and Mahathir, who supposedly wants his son to take Najib’s place. But Kedah, where Mukhriz remains extremely popular, and Johor, where the sultan met Muhyiddin in a show of support after he was pushed as deputy prime minister, are two areas that are crucial to electoral success for UMNO. In addition to Mukhriz and Muhyiddin, others scheduled to be ousted are party vice-president Mohd Shafie Apdal, who is equally popular in Sabah, a largely Christian or tribal region in East Malaysia which UMNO found critical to maintain itself in power in the 2013 general election. Others are MPs Aziz Sheikh Fadzir and Jumat Idris and former Terengganu chief minister Ahmad Said, all of whom are local politicians with electoral followings. Earlier, officials ordered the expulsion of Anina Saadudin, a Langkawi women’s wing delegate who caused a storm with an impassioned rant saying the prime minister was urinating on the heads of the 3 million party rank and file. A YouTube video of the young woman’s tirade went viral and was seen by tens of thousands of people. Mukhriz told the independent news website Malaysiakini he hasn’t heard of any action ousting the seven. However, recently in the city of Alor Setar in Mukhriz’s home state, Najib is said to have told an UMNO division meeting that it was okay to undermine Mukhriz because Mukhriz “had it easy,” referring to his appointment as chief minister – that he put Mukhriz in and that the former prime minister’s son should toe the line on the controversies surrounding 1MDB, the unpopular goods and services tax, an 18–month postponement of UMNO intraparty elections and other hot-button issues. “The stage is set to get rid of Mukhriz and replace him with Alor Setar UMNO chief Senator Ahmad Bashah Md Hanipah, who goes back a long way with Najib,” according to Imran Imtiaz Shah Yacob, a Mukhriz supporter. “Ahmad Bashah’s long burning desire for the [chief minister’s] post is an open secret.”

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2022-05-18T05:47:43Z

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In our end of year review (here) we covered Myanmar’s misery following the military coup of February 2021. Since General Min Aung Hlaing seized power as Chairman of the State Administration Council and then named himself prime minister, the situation in the south-east Asian nation has gone from bad to worse: demonstrations suppressed with lethal force, thousands arrested and tortured, and elected ministers and mayors thrown into prison. In recent weeks the army has launched an offensive against rebels in the eastern states of Karen and Kayah, forcing more than 100,000 people to flee their homes. This number includes around ten thousand refugees who crossed the border into Thailand. An estimated 1,400 civilians have died in the violence in Myanmar since the coup, which Human Rights Watch says constitutes a crime against humanity. Grim news escalates The Financial Times (here) reported further air strikes last week. The strikes killed civilians, including a seven-year-old girl in Hpruso, the same township where more than thirty people were killed and their bodies burnt by government troops on Christmas Eve. With the world distracted by the crisis in Ukraine, the Myanmar military has been stepping up its violence. Enough is enough Now, TotalEnergies and Chevron have said that enough is enough. Good on them. TotalEnergies’ CEO Patrick Pouyanné wrote to Human Rights Watch last week (here), saying that his company supports targeted sanctions by the European Union and the USA against the military government of Myanmar, and also against Myanmar’s state owned energy company MOGE. TotalEnergies said that whilst it would be illegal for it to stop paying taxes to the government, “we have decided to make donations to human rights organisations in Myanmar in an amount equivalent to the taxes actually paid by our subsidiary to the Myanmar State Treasury.” The company has been vocal in its condemnation of the junta. Mr Pouyanné writes how “TotalEnergies has repeatedly, publicly and very firmly condemned both the violence and the human rights abuses committed in Myanmar.” Coming from a company the size and status of TotalEnergies, this is impressive and commendable. Yadana and the military-industrial complex TotalEnergies is the operator of the offshore Yadana field, and is a partner in the Moattama Gas Transportation Company, which transports gas from the field for export to Thailand. State-owned MOGE is also a partner in the pipeline and the field, along with Chevron. Last May, the pipeline company suspended all cash dividends to shareholders as TotalEnergies and Chevron faced criticism for paying out cash from their operations to the government. TotalEnergies’ production from the Yadana gas field currently supplies half of Myanmar’s domestic gas consumption and around 12 per cent of gas consumed by neighbouring Thailand. Natural gas from Yadana and other fields comprised 40 per cent of Myanmar’s exports and 20 per cent of government revenues in fiscal year 2018-19, the most recent for which data exists. Gas sales generate over US$1 billion in foreign revenue for the military government of Myanmar every year, and these revenues are its single largest source of foreign currency income. PTTEP and MOGE remain Cutting off the gas supply to western Thailand and to Myanmar’s largest city, Yangon, by suspending production from Yadana would not be responsible or ethical, TotalEnergies and Chevron decided. We agree. However, the pair have now committed to exiting their stakes in the field and the pipeline company. They will walk away from the assets, leaving Thailand’s state energy company PTTEP and MOGE as the sole remaining shareholders. TotalEnergies and Chevron have served notice under the operating agreements that within six months they will relinquish their shares for no fee, and either MOGE or PTTEP should take over as operators. Human Rights Watch gives full support Human Rights Watch praised TotalEnergies’ decision in a press release here. “With TotalEnergies’ announcement, governments now have no reason to oppose or avoid tough measures that show support to the millions of people in Myanmar who want justice and accountability,” commented John Sifton, Asia advocacy director at Human Rights Watch. “Junta leaders are only going to turn away from their brutality and oppression if the economic costs of their abuses are too great for them to bear. “TotalEnergies’ support for sanctions should be an example to other energy companies operating in Myanmar, as well as to the Thai government, the single biggest buyer of Myanmar gas. Board members and institutional investors in other companies should push them to follow TotalEnergies’ decision.” Block the banks clearing dollars and euros Human Right Watch has called on the EU and the US to impose sanctions quickly, and to block payments to the junta in euros and dollars. At the moment, banks in Thailand, Singapore, South Korea, and China continue to process payments for gas sales for MOGE and the government. However, foreign banks must comply with EU and US law if sanctions blocked EU and US banks from processing payments to the junta in euros or US dollars. Therefore, even if Thailand, Singapore, South Korea, and China do not pass sanctions themselves (and such a move would be highly unlikely from any of the four), banking sanctions in euros and dollars would make life difficult for the junta. Whether the pain will be sufficient to force the generals to abdicate and restore power to democratically elected officials remains to be seen. But as democracies, Singapore and South Korea should be joining TotalEnergies and Chevron in taking a stand against a brutal regime that has violated international norms and killed hundreds of its own people. What does it say about the integrity of prime minister Lee Hsien Loong of Singapore if a French oil and gas company takes a stronger stand on human rights abuses than he does? Bad publicity and activist pressure last time I will admit that the decision by the two western oil companies is not driven by pure altruism. During the last period of military rule in Myanmar in the 1990s and early 2000s, which was equally violent and brutal, western oil companies with operations in Myanmar were hammered by activists and human rights lawyers. Chevron was hauled through the courts by victims of atrocities in Myanmar who lost their homes and claimed they were abused in the construction of the Moattama pipeline. Britain’s Premier Oil ended up selling its stake in the offshore Yetagun field in the Andaman Sea to Petronas of Malaysia in 2003 after various shareholder protests and activist boycotts. Now the pressure mounts The latest coup has proved to be as contentious as the last, and pressure has been building up on investors in Myanmar’s oil and gas sector ever since the military government took power. We have seen how Transocean is keen to hide its contracts in country by declining to name where rigs that are deployed in Myanmar are working on its fleet status report. Already in April, Upstream was reporting demonstrations against the coup by staff and expatriate Burmese outside Chevron’s headquarters (here). Australian trade unions reported that three thousand people “rallied against Woodside” in Perth, Australia in February (here). Another big investor, Norway’s telecoms operator Telenor, is also trying to withdraw from Myanmar, facing pressure from sanctions and activists. The company announced it was selling its telecom operations there to M1, an investment firm owned by the family of Lebanese Prime Minister Najib Mikati, Reuters has reported here. Unfortunately, the junta then demanded that a local company also take a stake in the venture, which has stalled the process. Myanmar’s government is toxic and few responsible corporates want to be associated with it. Silence on A-6 But there is silence on one key issue. TotalEnergies and its partner Woodside have a major undeveloped gas field in Myanmar’s offshore Block A-6, as we reported here. Whilst work has been suspended on the block, TotalEnergies has given no indication that it is quitting the block. And why would it? The initial development plan was based on up to 10 deepwater wells tied back to a subsea production system and a shallow-water processing platform, with an initial production rate of 60 million cubic feet (1.7 million cubic metres) per day of gas. If the regime of general Min Aung Hlaing eventually falls, then Total and Woodside can restart their development plans and bring the deepwater block to production quickly. Than Shwe, the former general who was the head of state of Myanmar from 1992 to 2011 and another self-appointed prime minister, eventually had to step down after two decades in power, and then the National League for Democracy won elections by a landslide. This is a long game. Like the people of Myanmar, TotalEnergies and Woodside are going to need to be patient. Yetagun field force majeure Meanwhile, Petronas has dodged the ethical and moral challenges that TotalEnergies and Chevron have had to face in Myanmar, but not by choice. In April, the Malaysian state-owned energy company suspended production at Yetagun gas field and declared force majeure, not because of any inherent opposition to the military government, but because the field’s output declined significantly. “Prior to the cessation of production, Yetagun field was producing well below the technical turndown rate of its facilities,” Petronas said in its announcement (here). “There has been a drastic decline in production level due to subsurface challenges in the field since January 2021 and it has further deteriorated recently. Continuing to produce at a low rate would impose significant risks to the integrity of our assets and the safety of our people. As a responsible operator, we had to temporarily cease production and declare force majeure.” Also, it’s not clear when production from the field will restart. And then, there were two PTTEP and Posco of Korea are now the two remaining offshore operators with production in Myanmar. Can they stand the heat as the regime continues to kill, shoot, torture and imprison? We’ll keep you posted. Reminder: you can read TotalEnergies’ letter to Human Rights Watch here. Full history of the Yadana gas field is here. Details of current American sanctions on Myanmar are here. This anonymous commentator is our insider in the world of offshore oil and gas operations. With decades in the business and a raft of contacts, this is the go-to column for the behind-the-scenes wheelings and dealings of the volatile offshore market.

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Get ready to party like its 4710! On Monday, January 23, the Chinese calendar celebrates the new year and 2012 is the year of the dragon. Family Fun has posted a really cute dragon craft project that your children will love. To make this festive dragon, visit Family Fun. Pastries for Pets Everyone loves baked goods, even your pets! KRQE did a great piece about how former Las Vegas real estate agent Daphne Wright opened the Pooch Pantry, Bakery and Boutique in Santa Fe. The store’s specialty is baked goods for pets, a topic Daphne became interested in after two of her dogs developed diabetes. I’m sure you’re wondering, so the answer is yes: the treats are all natural and delicious for people too! To view the video, visit KRQE Santa Fe. Vintage Around the World Shopping for vintage clothing isn’t just popular in the United States. Peggy Loh of Malaysian newspaper New Straits Times writes about how 1950s fashion styles and fabrics are becoming popular again in the southeast Asian country. To learn more about the vintage fashion scene in Malaysia, visit the New Straits Times. Facebook for Blockheads Every crafter has played with Lego blocks at some point. To help connect fans from all over the world, Lego has launched the new ReBrick social network, which allows builders to share pictures of their current projects with other like-minded fans. To join this community, visit ReBrick. Is this the future of home crafting? Kiwi Crate, a service that sends your family a monthly package of craft projects, has announced that it has secured an additional $5 million in funding. Kiwi Crate has a growing subscriber base and was awarded Maker Faire’s 2011 Education Award. To learn more about the company, visit Kiwi Crate.

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Cost Of Bauxite Mining Equipments. cost of bauxite mining equipments greenrevolution Bauxite Bauxite Products Bauxite Suppliers and ACTIVATED BAUXITE is an.Bauxite Mine Plant And Equipment Supplier. Bauxite Processing Plant India Equipment Gambia 2019220 India Is A Global Producer Of Chromite Coal Iron Ore And Bauxite Bauxite Mining Plant And Bauxite Crusher Machine For Sale Price Supplier In India Bauxite Mining Equipment In Ghana Mineral 27 01 2018183. Bauxite Price, 2021 Bauxite Price Manufacturers. Bauxite machinery cost price in thailand gold mining equipments. Rotary Scrubber is a cost effective bauxite washing unit that is Bauxite crusher is the main equipment used for bauxite mining and crushing,as a offers various.Capital and operating cost of ball mill for bauxite mineral. Paragominas bauxite mining costs Jan-Sep 2011. 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CRU Bauxite Cost Service - Bauxite Mining Costs and Bauxite CRU's Bauxite Cost Service 2014 Edition, published Tuesday 13th May, reports that global average bauxite mining site costs decreased by 3.6 in 2013. better-informed decisions about your mining business or mining.Bauxite Mining • Western Australia Chris Flynn This article seeks to explore some of the interrelationships between economic interests and environmental consequences. The extreme case in question is Alcoa's which cost the West Australian taxpayer over $70,000, and it is doubtful if it will ever be made pUblic. Cost Of Bauxite Mining Equipments Edeka. Cost of mining bauxite ore. Cbg bauxite aluminium ore mining operations mining technology the largest single producer of bauxite aluminium ore in the world cie des of the kamsar bauxite treatment plant on the west african coast and a group of of calcined bauxite and has to.May 03, 2021 Metro Mining has flagged “historically high” freight costs for shipping its bauxite product, which the company anticipates will negatively impact prices. The company stated Chinese buying. List of equipment that is New Type in bauxite mining. 2021-5-18 Miner. SBM equipment price list bauxite calcination cone crusher ----- Brief introduction bauxite calcination cone crusher is widely used for all kinds of medium and fine crushing rocks with compressive strength under 350MPa in,cement industry, sand industry, metallurgy and other fields bauxite calcination cone crusher is.Bauxite mining equipments. mining machinery for magnesite ore mineral . Inquiry Online. low cost bauxite ore mining machine for sale. low cost bauxite ore mining machine for sale. low cost bauxite ore jaw crusher for sale. used stone crusher for sale in india used crusher plant cost aug used stone . Some of the common funding requirements that business owners try and take advantage of, including those starting a Bauxite Mining Business business include to help with purchase of new or used equipment, expansion capital, product or service development costs.Extraction of aluminium from bauxite ore Products. As a leading global manufacturer of crushing, grinding and mining equipments, we offer advanced, reasonable solutions for any size-reduction requirements including, Extraction of aluminium from bauxite ore,. Approx Cost Of Bauxite Ore Processing Plant To Alumina. 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Bauxite is generally extracted by open cast mining, being almost always found near the surface, with processes that vary slightly depending on the location. Before mining can commence the land needs to be cleared of timber and vegetation. Jan 20, 2016 Bauxite in Malaysia The environmental cost of mining. Bauxite mining has become a controversial political issue in Malaysia. As the government implements a.Aug 03, 2021 Bauxite mining requires relatively low energy inputs, compared to other steps in the aluminium production process – with less than 1.5 kilograms of fuel oil (mainly in the form of diesel for haul trucks) and less than 5 kWh of electricity consumed per tonne of bauxite extracted. Or incidental to Mining Sorting of Bauxite. The Quality of Bauxite produced from Bodai- Daldali Mines by sorting and sizing should have Minimum 45.30 Al2O3 Grade Maximum 3.70 SiO2 OR as grade specified by Mines Manager in the monthly mine plan. Mining, Sorting, Breaking and Stacking of bauxite material. 1.Dec 02, 2020 The average thickness of the bauxite ore zone is about 6 to 8m, which makes mining operation quite simple and cost-efficient. Guinea ore is natural low silica (2.5 ), medium alumina (44-46 ) gibbisitc bauxite, where reactive silica is only 1.2 to 1.5 , which makes this one of the best aluminium ore in the world. Jan 23, 2021 2. The ASIC Lifetime Cost to Mine a Bitcoin. In this second assessment we find that the average cost to mine a bitcoin is about $13,000, considering the cost of the hardware and expected lifetime. Below we discuss methodology, assumptions, and results. Mining Rigs. ASICs for bitcoin mining currently cost between $500 – $8,000 per unit.The update follows the completion of detailed mine scheduling and de-risking of mining costs via mining contractor contributions to the Minim Martap PFS2, and reinforces the ability of the Project to produce one of the highest grade, lowest contaminant bauxite products of any mine globally for.

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Just like there is a good and bad side of everything, similarly, world cinema has side too where it shows the reality of the world. While sex is a very important part of our lives and world cinema has become bold now to depict it on the silver screen. But, still there are some movies which show the extreme side of sex, we are talking about abuse and sexual violence. Also, sometimes these sensual scenes hurt religious sentiments of a particular group. Whatever may be the reason, there are some movies that were banned worldwide for showing explicit content mainly sex, erotic and violence scenes. Check out the list below. 5. Last Tango in Paris (1972) Last Tango in Paris is a Franco-Italian erotic drama film directed by Bernardo Bertolucci. While the plot revolves around a recently widowed American who begins an anonymous sexual and erotic relationship with a beautiful young Parisian woman. The sexual violence in the movie led to international controversy. And the movie got banned in many countries namely Argentina, Chile and Italy, for being too “obscene” and “pornographic”. 4. The Human Centipede 2 – Full Sequence (2011) It is a Dutch black and white exploitation horror film. It is written, directed, and co-produced by Dutch filmmaker Tom Six. While it is a sequel to 2009 film The Human Centipede (First Sequence). The plot revolves around a mentally impaired English man who watches and becomes obsessed with the first Human Centipede film and decides to make his own “centipede” having twelve people. Moreover, it joined the list of the movies that were banned in countries like Australia, New Zealand because of its violence and sexually explicit content. 3. Ken Park (2002) Ken Park is a drama film written by Harmony Korine. The plot of the movie depicts the abusive and violent relationship of several teenagers with and without their parents. While the film got banned in countries like Australia, for depicting teenage sex, incest and auto-erotic asphyxiation. Also, check out: 10 Times Actors Had Real Sex In Mainstream Movies or On-Screen 2. Hail Mary (1985) Hail Mary is a French film written and directed by Jean-Luc Godard. The film is a modern retelling of the story of a virgin birth. While the plot revolves around a student Mary who get pregnant without any intercourse and she comes to terms with God’s plan through meditations. It is one of the movies that were banned because of the blasphemous and sexual content, in countries like Argentina and Brazil. Moreover, some scenes showing full frontal nudity offended some Christians all over the world. 1. Fifty Shades of Grey (2015) Fifty Shades of Grey is an American erotic romantic drama film directed by Sam Taylor-Johnson. The plot of the movie revolves around a Literature student whose life change when she meets handsome, yet tormented billionaire Grey and how Grey got Anastasia into BDSM. It is one of the modern movies that were banned in countries like UAE, Indonesia, Malaysia. While it was banned for showing insane romance, numerous sex scenes and violent sex. Also, let us know other movies that were banned in your country. And please make sure to share it with your friends.

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88 Jalan Malut Wang Temoyong, Pantai Cenang, Malaysia This destination can have additional per person taxes which are excluded in the prices below Situated within the scenic parkland of Pantai Cenang, Wang Valley Resort offers comfortable accommodation and a wide range of facilities, including a 24-hour reception, an outdoor pool and free Wi-Fi.... Distance to city centre Policies vary by room type and provider. +60 183 876 707 Yes. Many people visiting Pantai Cenang look for a hotel with a pool. Wr Valley Resort has a pool on site that hotel guests may use, but be advised that hotels typically have rules in regard to pool usage. For questions about Wr Valley Resort and your reservation, contact the front desk directly at +60 183 876 707. Yes, Wr Valley Resort has Wi-Fi available to hotel guests. 12:30 PM. If you require a later check-out we advise discussing it with the front desk as soon as you’re able to. Check-in time is 2:00 PM.

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Finding home tutors in Kota Bahru and in other cities in Malaysia is now easy with MyPrivateTutor. We also help you find tuition classes and coaching centers in Kota Bahru as well as online tutors. Home tuition helps to get higher marks and increase confidence. Use our portal to find the best local tutors, tutorial centers and tuition classes in Kota Bahru. I am a beginner but already have some experience by teaching my siblings and friend. For me, teaching is a process of learning. We can learn something together. BArch (Hons) in Architecture Experience: 2016: A level Maths and physics tutor (for fellow friends) July 2017: art teacher at Egypt (volunteering event) Jun-July 2018: MUET tutor (for a group of form six students) Nov 2019: mathematics teacher (sek ren Islam al-qari) My tutor's outline is as follows: 1. INTRODUCTORY TEST Student will be given a test to assess their understanding level, strengths and weaknesses of the subjects. This will determine the focus and direction of the lesson. 2. CONCEPTUAL LESSON Student will be tutored on conceptual understanding of the subjects based on the module requirement. At the end of this lesson, students will have a comprehensible understanding of the module. 3. A SERIES OF PRACTICE AND TRAINING TEST Student will practice on a series of topical tests to apply their understanding of their learnt conceptual lesson. This series of tests will expose them to the application of the conceptual lesson in daily life and train them to the effective way in solving the related problems. On going Phd, Master in Heath Entrepreneurship, Degree in Health Entrepreneurship Degree in Health Entrepreneurship (2011-2015), Master in Health Entrepreneurship (2015-2018), Phd in Health Entrepreneurship (2018-present). Part time lecture for Health & Education Promotion subject. Invitation tutor for Physiology and Physiotherapy subject. Bachelor Education (Physical Education ) and Science Health Experience teaching secondary student prepare dor SPM and PMR. Experience teaching at nursery for 4-6 years old student. Appear for O` Level I am habituated on teaching students since last 2 years non-commercially. I am a young and friendly teacher, and can understand the problems you are facing. Responsible for those who are eager and interested to be an English expert. I am setting up for my O-levels. I always try to follow international standards and professions, but my intention is to understand my students and get my students to understand me which is the perfect way of teaching and learning. I analyze and direct every students within their level of knowledge which makes it easier to cooperate.

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Pakistan Telecommunication Authority (PTA) has recently given approval to edotco Pakistan Private Limited (edotco PK) on the change of shareholding in edotco PK by way of subscription by Dawood Hercules Corporation Limited (DH Corp) of 45% of the share capital of edotco PK, an end-to-end telecom infrastructure services company. This positive decision of the Government and the Regulator is a welcome promotion of the digital agenda making Pakistan an attractive destination for foreign investment. The above marks one of the approvals related to the transaction steps on the acquisition by edotco PK of Jazz’s portfolio of 13,000 tower assets currently under Deodar Private Limited (Deodar). Further regulatory approvals are in process of being granted by PTA on the change of shareholding structure in Deodar, and by State Bank of Pakistan on the funding of the acquisition. Established in 2012, edotco is the first regional and integrated telecommunications infrastructure services company in Asia, providing end-to-end solutions in the tower services sector from tower leasing, co-locations, build-to-suit, energy, transmission and operations and maintenance (O&M). (Owned by Axiata) edotco operates and manages a regional portfolio of over 27,000 towers across core markets of Malaysia, Myanmar, Bangladesh, Cambodia, Sri Lanka and Pakistan with over 16,500 towers directly operated by edotco and a further 10,500 towers managed through a range of services provided.

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Aisyah Mohd Soberi or better known as Kak Aisyah Aisyah Mohd Soberi or better known to the members of the faculty as Kak Aisyah, is a name commonly associated with smiles and laughter but that is not all; she is also known for her contributions to the faculty in her multiple roles as the Project Manager for the Legal Aid Clinic, Community Outreach Program (COP) and the Asean LIP. She started her journey as a law student without even wanting to read law in the first place. A classic example of how God gave something she never thought she would survive, but here she is today. She graduated from the University of Malaya in 2010 where she continued practicing in litigation for approximately four years. In 2014, she started her Master's Degree from University Malaya and graduated recently in 2017. Additionally, Aisyah also has a Diploma in Shariah and Legal Practice from the International Islamic University Malaysia (IIUM). Aisyah during her degree days in Faculty of Law, University of Malaya. Aisyah is also known for her contribution in aiding the establishment of the Legal Aid Clinic of the Faculty of Law, University of Malaya. Her journey started in 2014 where she started as a volunteer at the legal aid by doing basic research and reading. Due to her inclination to social justice, she was offered the job as a Project Manager in September 2014. Being a Project Manager involves supervising and aiding the following three main projects which are the Legal Aid Clinic, Community Outreach Program (COP) and the Asean LIP. In regards to the Legal Aid Clinic, Aisyah is tasked to assist the faculty in establishing and managing the Clinic. Therefore, she has to find supervisors, prepare manuals and train students. Aisyah went to various local universities to research on suitable manuals and guidelines to suit the needs of the Faculty. To this date, Aisyah has thirty student advisors and ten supporting advisors to aid her. Her greatest achievement would be the official launch of the Legal Aid Clinic on the 2nd of October 2017 by Dato' Sri Azalina binti Othman Said, a Minister in the Prime Minister’s Department. The successful launch was a collective hardwork of the Dean of the Faculty of Law, the KBGUM Committee, the KBGUM Launch Committee, lecturers and students. Aisyah and her fellow members of the Community Outreach Program. Next, Aisyah is also actively involved in helping to manage the Community Outreach Program (COP) which has always been close to her heart, as she was also a COP member during her university days. She has always loved community work and being in COP had opened her eyes to a new horizon whereby it gave her insight on how is it to be behind bars, or what it feels like to be labelled as problematic individuals. Most importantly, she learnt that some people are misguided and instead of judging or marginalising them, we should get into their shoes and understand their perspectives. Aisyah is of the view that children are different from adults, and as such they need proper teaching and guidance. Thus, by going to the Boy's Kajang Prison, Tunas Bakti and Henry Gurney she could contribute back to the community and help the children. In assisting the COP, she would explain to the student volunteers on how to conduct lesson plans and instil the importance of doing pro bono works. She mentioned that life is not always about earning a handsome salary but to help facilitate access to justice and disseminating legal awareness to the people in need. According to Aisyah, “hope is the best feeling we could give in COP, where we could help people and not make their life so bad”. She hopes that the student volunteers will be able to understand that by joining COP, they could find the balance between earning and to fulfil a duty towards the society, as justice is not only for those who can afford it, but it is everybody’s right. Aisyah and her fellow members of the Legal Aid Clinic. Beyond COP, Aisyah is also involved in assisting the Faculty in the Asean LIP- a legal information portal. This is a project by the Faculty of Law and a company called MKMS. The purpose of this portal is to provide access to information for the development of law around ASEAN countries whereby updates on new cases and legislation are posted. Aisyah serves as the Secretary for the Asean LIP where she is involved with the establishment of the portal, by providing the initial paperwork and facilitate meetings. Apart from her involvement in these various projects, Aisyah is also a certified mediator, and she also spends her time as a trainer and manager for the National Client Consultation Competition. Furthermore, she is also the Coach for the Moot Bahasa Melayu for two years in a row. Aisyah as one of the speakers at the Asia Pro Bono Conference, held at Faculty of Law, University of Malaya. Recently, Aisyah was also involved in the Asia Pro Bono Conference, which was held at the Faculty of Law, the University of Malaya which involves various countries around Asia. She was given the honour to be the speaker and moderator for the said event where she spoke among esteemed speakers and experts on pro bono. Despite all her commendable social involvements and achievements, Aisyah noted that as a normal human being, there were times that she broke down, but she was thankful to have a strong support system. She mentioned that her mother, her husband, family and family-in-law were her biggest supporters. Aisyah believes that “When we break down, we should get up again and do not get carried away by emotions, suppressing feelings would only cause problems". As a person who takes mental health very seriously, she believes that sugarcoating the problem would not solve any problems. Last but not least, Aisyah holds strongly to the motto “disaat orang cuba pecah belahkan masyarakat, kita patut bersama". In regards to her future plans, she is going to continue her PhD soon, and she hopes that her story could provide an insight into the life of volunteering and serving the community.

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The Finnish oil company is shamelessly riding on the band's popularity, according to environmental advocacy group After establishing a cooperation with the Finnish oil giant Neste to cut their touring emissions last week, the rock band Coldplay were panned as "useful idiots for greenwashing" by a climate advocacy group. According to a report by Friends of the Earth, while Neste claims to be the world's largest producer of sustainable biofuels, its palm oil suppliers cut at least 10,000 hectares (24,710 acres) of forest in countries like Indonesia and Malaysia between 2019 and 2020. Carlos Calvo Ambel, a senior director of the Transport and Environment campaign group (T&E) said: “Neste is cynically using Coldplay to greenwash its reputation. This is a company that is linked to the kind of deforestation that would appall Chris Martin and his fans. It’s not too late, they should drop their partnership with Neste now and focus on truly clean solutions instead.” After news of the T&E report broke, shares of Neste ended lower on May 11 on the Helsinki Exchange, closing the day at roughly 39 euros per share from a high of 40.56 euros. After Martin admitted in a BBC interview last year that a "backlash" against their emissions record was fair, the award-winning rock band announced efforts to reduce their touring footprint. Coldplay's current "Music of the Spheres" world tour, which includes a kinetic-powered dancefloor and other green elements, will see a tree planted for every ticket sold. A statement from the band said: “When we announced this tour, we said that we would try our best to make it as sustainable and low carbon-impact as possible … Before we appointed Neste as supplier of these biofuel products, we received their guarantee that they do not use any virgin materials in their production – most especially not palm oil. It’s still our understanding that they use renewable waste products only, like cooking oil and byproducts from wood pulp manufacture.” Neste spokeswoman Hanna Leijala said the company “does not accept any sustainability violations in our own operations. “For our collaboration with Coldplay, conventional palm oil was not used as a raw material” she said, adding: “Neste plans to reduce the share of conventional palm oil to 0% of its global renewable raw material inputs by the end of 2023.” Crude palm oil currently accounts for 7% of the company's fuel inputs. Used cooking oil, animal fats, and other wastes and residues are combined into its jet fuel. Neste, however, refused to specify how much of the jet fuel is made up of palm fatty acid distillates (PFADs), claiming "contractual and competitive reasons." Coldplay put their tour on hold in 2019 until they could do so in a more sustainable manner. According to the statement announcing the partnership, the band would reduce touring-related emissions by using Neste’s MY Sustainable Aviation Fuel, which can lower carbon emissions on flights by up to 80% when compared to conventional jet fuel, and Neste MY Renewable Diesel, which would be used for trucks hauling their equipment.

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https://www.wealthprofessional.ca/investments/socially-responsible-investing/coldplay-dubbed-useful-idiots-for-greenwashing-after-neste-collaboration/366556

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