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In the past 50 years, sexual and reproductive health and rights have been increasingly recognized as critical components of overall health and well-being. (1,2) The 1975 World Health Organization (WHO) [...]

INTRODUCTION HIV?related stigma and discrimination constitute significant barriers to HIV responses around the world. Fragmentation of efforts to address HIV?related stigma and discrimination has hampered progress to date. To strengthen [...], : Introduction: There is strong global commitment to eliminate HIV?related stigma, and work in this area continues to evolve. Wide variation exists in frameworks and measures used. Methods: Building on the existing knowledge syntheses, we carried out a systematic review to identify frameworks and measures aiming to understand or assess internalized stigma, stigma and discrimination in healthcare, and in law and policy. The review addressed two questions: Which conceptual frameworks have been proposed to assess internalized stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? Which measures of these different types of stigma and discrimination have been proposed and what are their descriptive properties? Searches, completed on 6 May 2021, cover publications from 2008 onwards. The review is registered in PROSPERO (CRD42021249348), the protocol incorporated stakeholder input, and the data are available in the Systematic Review Data Repository. Results and discussion: Sixty?nine frameworks and 50 measures met the inclusion criteria. Critical appraisal figures and detailed evidence tables summarize these resources. We established a compendium of frameworks and a catalogue of measures of HIV?related stigma and discrimination. Seventeen frameworks and 10 measures addressed at least two of our focus domains, with least attention to stigma and discrimination in law and policy. The lack of common definitions and variability in scope and structure of HIV?related frameworks and measures creates challenges in understanding what is being addressed and measured, both in relation to stigma and efforts to mitigate or reduce its harmful effects. Having comparable data is essential for tracking change over time within and between interventions. Conclusions: This systematic review provides an evidence base of current understandings of HIV?related stigma and discrimination and how further conceptual clarification and increased adaptation of existing tools might help overcome challenges across the HIV care continuum. With people living with HIV at the centre, experts from different stakeholder groups could usefully collaborate to guide a more streamlined approach for the field. This can help to achieve global targets and understand, measure and help mitigate the impact of different types of HIV?related stigma on people's health and quality of life.

Preventing new HIV infection remains a major challenge in our response to the HIV epidemic. A diagnostic assay that could rapidly identify acutely infected individuals who are not yet antibody [...]

Preventing new HIV infection remains a major challenge in our response to the HIV epidemic. A diagnostic assay that could rapidly identify acutely infected individuals who are not yet antibody [...]

The financial crisis of 2007-2008 forced U.S. President Barack Obama and his administration to reconcile with the need to 're-regulate' the financial markets. According to the president, the 2010 Dodd-Frank [...]

Introduction The world health rePort2008 draws attention to the significance of policies for achieving primary health care objectives, including both those necessary to make health systems function properly and those [...], This paper describes the development of a tool that uses human rights concepts and methods to improve relevant laws, regulations and policies related to sexual and reproductive health. This tool aims to improve awareness and understanding of States' human rights obligations. It includes a method for systematically examining the status of vulnerable groups, involving non-health sectors, fostering a genuine process of civil society participation and developing recommendations to address regulatory and policy barriers to sexual and reproductive health with a clear assignment of responsibility. Strong leadership from the ministry of health, with support from the World Health Organization or other international partners, and the serious engagement of all involved in this process can strengthen the links between human rights and sexual and reproductive health, and contribute to national achievement of the highest attainable standard of health. Le present article decrit le developpement d'un outil faisant appel a des concepts eta des methodes relevant des droits de l'homme pour ameliorer les lois, les reglementations et les politiques pertinentes en rapport avec la sante sexuelle et genesique. Cet outil vise a faire prendre conscience et a ameliorer la comprehension des obligations des Etats en matiere de droits de I'homme. II comprend une methode pour examiner de maniere systematique la situation des groupes vulnerables, impliquer des secteurs autres que celui de la sante, promouvoir un processus veritable de participation de la societe civile et mettre au point des recommandations en vue d'eliminer les obstacles reglementaires et politiques a la sante sexuelle et genesique, avec une affectation claire des responsabilites. Un role moteur fort assume par le Ministere de la sante avec I'appui de l'Organisation mondiale de la Sante ou d'autres partenaires intemationaux ainsi que I'engagement serieux de tous les participants a ce processus peuvent renforcer les llene entre droits de I'homme et sante sexuelle et genesique et contribuer a I'obtention, au plan national, du niveau de sante le plus eleve possible. En este trabajo se describe el desarrollo de un instrumento que utiliza conceptos y metodos del campo de los derechos humanos para introducir mejoras en la legislacion, la normativa y las politicas relacionadas con la salud sexual y reproductiva. Dicho instrumento pretende ayudar a comprender mejor las obligaciones de los Estados en materia de derechos humanos y sensibilizar al respecto. Incluye un metodo que permite, de manera sistematica, estudiar la situacion de los grupos vulnerables, implicar a sectores distintos de la salud, promover un proceso de autentica participacion de la sociedad civil y formular recomendaciones para abordar las dificultades con que tropieza la salud sexual y reproductiva en materia de reglamentacion y politica, con una clara asignacion de responsabilidades. Un firme liderazgo del ministerio de salud, con el apoyo de la Organizacion Mundial de la Salud u otros asociados internacionales, y unido a un serio compromiso por parte de todos cuantos intervienen en este proceso, puede reforzar los vinculos entre los derechos humanos y la salud sexual y reproductiva, y contribuir a hacer realidad a nivel nacional el grado maximo de salud que se pueda lograr.

Introduction Despite increasing attention paid to the apparent integration of human rights into public health policies and programmes, it is difficult to find concrete examples of the benefits that have [...], There is general agreement on the need to integrate human rights into health policies and programmes, although there is still reluctance to go beyond rhetorical acknowledgement of their assumed significance, To determine the actual value of human rights for the effectiveness of public health efforts requires clarity about what their incorporation looks like in practice and how to assess their contribution. Despite the pervasive use of indicators in the public health field, indicators that specifically capture human rights concerns are not well developed and those that exist are inconsistently used. Even though 'health and human rights indicators' are increasingly being constructed, it is often the case that health indicators are used to draw conclusions about some interaction between human rights and health; or that law and policy or other indicators, traditionally the domain of the human rights community, are used to make conclusions about health outcomes. To capture the added value that human rights bring to health, the differences in the contributions offered by these indicators need to be understood. To determine the value of different measures for advancing programme effectiveness, improving health outcomes and promoting human rights, requires questioning the intended purpose behind the construction of an indicator, who uses it, the kind of indicator it is, the extent to which it provides information about vulnerable populations, as well as how the data are collected and used. Il existe un consensus sur la necessite d'integrer les droits de l'homme aux politiques et aux programmes sanitaires, malgre une certaine reticence a aller au-dela de la reconnaissance rhetorique de leur importance supposee. Pour determiner ce qu'apportent reellement les droits de l'homme a l'efficacite des efforts en faveur de la sante publique, il faut avoir une idee claire de la forme que prend leur integration dans la pratique et des modalites d'evaluation de leur contribution. En depit de l'usage envahissant des indicateurs dans le domaine de la sante publique, on ne dispose pas encore d'indicateur bien au point qui rende compte specifiquement des preoccupations liees aux des droits de l'homme et les indicateurs existants ne sont pas utilises de maniere systematique. Si l'on construit de plus en plus d'indicateurs du type << sante et droits de l'homme>>, il est frequent que ces indicateurs soient utilises pour tirer des conclusions sur certaines interactions entre les doits de l'homme et la sante ou que des indicateurs du type << loi et politique >> ou autres, relevant traditionnellement du domaine des droits de l'homme, servent a formuler des conclusions sur des resultats sanitaires. Pour rendre compte de la valeur ajoutee que les droits de l'homme apportent a la sante, li faut comprendre les differences entre les contributions representees par ces indicateurs. Pour determiner la valeur de differentes mesures de la progression de l'efficacite programmatique, de l'amelioration des resultats sanitaires et de la promotion des droits de l'homme, li faut se poser les questions suivantes : quelle est la finalite visee dans la construction de l'indicateur considere? Quels sont ses utilisateurs? De quelle nature est-il? Dans quelle mesure fournit-il des informations sur les populations vulnerables? et comment les donnees sont-elles recueillies et exploitees? Se reconoce en general que es necesario integrar los derechos humanos en las politicas y los programas de salud, pero hay aun cierta resistencia a ir mas alla del reconocimiento retorico de esa necesidad. Si se quiere determinar el impacto real de los derechos humanos en la eficacia de las iniciativas de salud publica, es preciso conocer con claridad como se manifiesta en la practica su incorporacion a esos esfuerzos y como debe evaluarse su contribucion a los mismos. Aunque el uso de indicadores esta muy extendido en el campo de la salud publica, los indicadores concebidos para reflejar aspectos de los derechos humanos no estan bien desarrollados o se usan de manera incoherente. Si bien se estan elaborando cada vez mas <>, ocurre a menudo que los indicadores sanitarios se utitizan para extraer conclusiones sobre algun tipo de interaccion entre los derechos humanos y la salud; o que indicadores relacionados con la legislacion y las politicas, tradicionalmente empleados por la comunidad de derechos humanos, son utilizados para sacar conclusiones sobre los resultados sanitarios. A fin de calibrar el valor anadido que los derechos humanos suponen para la salud, es preciso entender bien la diferente contribucion de esos indicadores. Para determinar el valor de las distintas medidas empleadas en lo que atane a imprimir eficacia a los programas, mejorar los resultados sanitarios y promover los derechos humanos, hay que preguntarse cual fue la finalidad perseguida al elaborar el indicador, quienes lo emplean, que tipo de indicador es, en due medida aporta informacion sobre las poblaciones vulnerables, y de que manera se recogen y usan los datos.

Too little is known about how an HIV diagnosis and access to care and treatment affect women's childbearing intentions. As access to antiretroviral therapy improves, greater numbers of HIV-positive women are living longer, healthier lives, and many want to have children. Effectively supporting women's reproductive decision-making in the context of HIV requires understanding how pregnancy, reproduction, and HIV intersect and asking questions that bridge the biomedical and social sciences. Considering women to be at the center of decisions on health policy and service delivery can help provide an appropriate constellation of services. A clear research agenda is needed to create a more coordinated approach to policies and programs supporting the pregnancy intentions of women with HIV.

Most people responsible for setting priorities in health have considerable expertise relevant to deciding how to use resources effectively and the kinds of improvements that should be emphasized. Most are also concerned with distributing improvements equitably. Accordingly, they often invoke human rights or principles of distributive justice to legitimize choices that create winners and losers. We propose an approach that draws on the strengths of both perspectives as a way to add legitimacy to efforts to set priorities in health. Our proposal provides a process for setting priorities but is not a formula or an algorithm for generating particular priorities. We propose an approach that would do away with the process through which priorities are set and decisions made, and suggest the value of a focus on the process of legitimizing these decisions.

Introduction Maternal and neonatal mortality have barely declined in the past two decades. The most recent estimates indicating that about 536 000 women die every year from pregnancy-related causes demonstrate [...], We describe the historical development of how maternal and neonatal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods to advance maternal and neonatal health. We describe the different contributions of the international community, women's health advocates and human rights activists. We briefly present a recent effort, developed by WHO with the Harvard Program on International Health and Human Rights, that applies a human rights framework to reinforce current efforts to reduce maternal and neonatal mortality. Bulletin of the World Health Organization 2008;86:589-593. Nous decrivons comment, au cours de l'histoire, on en est venu a considerer la mortalite maternelle et neonatale dans le monde en developpement comme un probleme de sante publique, puis un comme une question relevant des droits de l'homme et enfin comme l'un et l'autre, ce qui a conduit au developpement d'approches utilisant des concepts et des methodes empruntes aux droits de l'homme pour faire progresser la sante maternelle et neonatale. Nous presentons les differentes contributions de la communaute internationale, des defenseurs de la sante des femmes et des activistes en faveur des droits de la personne humaine. Nous presentons aussi brievement une initiative recente, developpe par l'OMS et le Harvard Program on International Health and Human Rights, qui applique le cadre des droits de l'homme pour renforcer les tentatives actuelles de reduction de la mortalite maternelle et neonatale. Se describe aqui el proceso historico por el que se Ilego a considerar que la mortalidad materna y neonatal en el mundo en desarrollo era un problema de salud publica y un factor que limitaba Ios derechos humanos, asi como la manera en que esas dos perspectivas han Ilevado a idear formulas basadas en principios y metodos de Ios derechos humanos para hacer avanzar la salud de la madre y del recien nacido. Se exponen las diferentes aportaciones de la comunidad internacional, los defensores de la salud de la mujer y los activistas en favor de Ios derechos humanos, y se presenta sucintamente una iniciativa reciente, puesta en marcha por la OMS y el Programa de Harvard sobre Salud Internacional y Derechos Humanos, que aplica un marco de derechos humanos para reforzar Ios esfuerzos desplegados en la actualidad con miras a reducir la mortalidad materna y neonatal.

Author(s): Justin M. Feldman 1,*, Sofia Gruskin 2, Brent A. Coull 3, Nancy Krieger 1 Introduction The National Vital Statistics System (NVSS), administered by the US government and based on [...], Background Prior research suggests that United States governmental sources documenting the number of law-enforcement-related deaths (i.e., fatalities due to injuries inflicted by law enforcement officers) undercount these incidents. The National Vital Statistics System (NVSS), administered by the federal government and based on state death certificate data, identifies such deaths by assigning them diagnostic codes corresponding to "legal intervention" in accordance with the International Classification of Diseases-10th Revision (ICD-10). Newer, nongovernmental databases track law-enforcement-related deaths by compiling news media reports and provide an opportunity to assess the magnitude and determinants of suspected NVSS underreporting. Our a priori hypotheses were that underreporting by the NVSS would exceed that by the news media sources, and that underreporting rates would be higher for decedents of color versus white, decedents in lower versus higher income counties, decedents killed by non-firearm (e.g., Taser) versus firearm mechanisms, and deaths recorded by a medical examiner versus coroner. Methods and findings We created a new US-wide dataset by matching cases reported in a nongovernmental, news-media-based dataset produced by the newspaper The Guardian, The Counted, to identifiable NVSS mortality records for 2015. We conducted 2 main analyses for this cross-sectional study: (1) an estimate of the total number of deaths and the proportion unreported by each source using capture-recapture analysis and (2) an assessment of correlates of underreporting of law-enforcement-related deaths (demographic characteristics of the decedent, mechanism of death, death investigator type [medical examiner versus coroner], county median income, and county urbanicity) in the NVSS using multilevel logistic regression. We estimated that the total number of law-enforcement-related deaths in 2015 was 1,166 (95% CI: 1,153, 1,184). There were 599 deaths reported in The Counted only, 36 reported in the NVSS only, 487 reported in both lists, and an estimated 44 (95% CI: 31, 62) not reported in either source. The NVSS documented 44.9% (95% CI: 44.2%, 45.4%) of the total number of deaths, and The Counted documented 93.1% (95% CI: 91.7%, 94.2%). In a multivariable mixed-effects logistic model that controlled for all individual- and county-level covariates, decedents injured by non-firearm mechanisms had higher odds of underreporting in the NVSS than those injured by firearms (odds ratio [OR]: 68.2; 95% CI: 15.7, 297.5; p < 0.01), and underreporting was also more likely outside of the highest-income-quintile counties (OR for the lowest versus highest income quintile: 10.1; 95% CI: 2.4, 42.8; p < 0.01). There was no statistically significant difference in the odds of underreporting in the NVSS for deaths certified by coroners compared to medical examiners, and the odds of underreporting did not vary by race/ethnicity. One limitation of our analyses is that we were unable to examine the characteristics of cases that were unreported in The Counted. Conclusions The media-based source, The Counted, reported a considerably higher proportion of law-enforcement-related deaths than the NVSS, which failed to report a majority of these incidents. For the NVSS, rates of underreporting were higher in lower income counties and for decedents killed by non-firearm mechanisms. There was no evidence suggesting that underreporting varied by death investigator type (medical examiner versus coroner) or race/ethnicity.

Introduction The World Health Organization (WHO) estimates that globally, 2 million AIDS patients in developing countries were receiving highly active antiretroviral therapy (HAART) in December of 2006, a more than [...], Background Little is known about the long-term drug costs associated with treating AIDS in developing countries. Brazil's AIDS treatment program has been cited widely as the developing world's largest and most successful AIDS treatment program. The program guarantees free access to highly active antiretroviral therapy (HAART) for all people living with HIV/AIDS in need of treatment. Brazil produces non-patented generic antiretroviral drugs (ARVs), procures many patented ARVs with negotiated price reductions, and recently issued a compulsory license to import one patented ARV. In this study, we investigate the drivers of recent ARV cost trends in Brazil through analysis of drug-specific prices and expenditures between 2001 and 2005. Methods and Findings We compared Brazil's ARV prices to those in other low- and middle-income countries. We analyzed trends in drug expenditures for HAART in Brazil from 2001 to 2005 on the basis of cost data disaggregated by each ARV purchased by the Brazilian program. We decomposed the overall changes in expenditures to compare the relative impacts of changes in drug prices and drug purchase quantities. We also estimated the excess costs attributable to the difference between prices for generics in Brazil and the lowest global prices for these drugs. Finally, we estimated the savings attributable to Brazil's reduced prices for patented drugs. Negotiated drug prices in Brazil are lowest for patented ARVs for which generic competition is emerging. In recent years, the prices for efavirenz and lopinavir-ritonavir (lopinavir/r) have been lower in Brazil than in other middle-income countries. In contrast, the price of tenofovir is US$200 higher per patient per year than that reported in other middle-income countries. Despite precipitous price declines for four patented ARVs, total Brazilian drug expenditures doubled, to reach US$414 million in 2005. We find that the major driver of cost increases was increased purchase quantities of six specific drugs: patented lopinavir/r, efavirenz, tenofovir, atazanavir, enfuvirtide, and a locally produced generic, fixed-dose combination of zidovudine and lamivudine (AZT/3TC). Because prices declined for many of the patented drugs that constitute the largest share of drug costs, nearly the entire increase in overall drug expenditures between 2001 and 2005 is attributable to increases in drug quantities. Had all drug quantities been held constant from 2001 until 2005 (or for those drugs entering treatment guidelines after 2001, held constant between the year of introduction and 2005), total costs would have increased by only an estimated US$7 million. We estimate that in the absence of price declines for patented drugs, Brazil would have spent a cumulative total of US$2 billion on drugs for HAART between 2001 and 2005, implying a savings of US$1.2 billion from price declines. Finally, in comparing Brazilian prices for locally produced generic ARVs to the lowest international prices meeting global pharmaceutical quality standards, we find that current prices for Brazil's locally produced generics are generally much higher than corresponding global prices, and note that these prices have risen in Brazil while declining globally. We estimate the excess costs of Brazil's locally produced generics totaled US$110 million from 2001 to 2005. Conclusions Despite Brazil's more costly generic ARVs, the net result of ARV price changes has been a cost savings of approximately US$1 billion since 2001. HAART costs have nevertheless risen steeply as Brazil has scaled up treatment. These trends may foreshadow future AIDS treatment cost trends in other developing countries as more people start treatment, AIDS patients live longer and move from first-line to second and third-line treatment, AIDS treatment becomes more complex, generic competition emerges, and newer patented drugs become available. The specific application of the Brazilian model to other countries will depend, however, on the strength of their health systems, intellectual property regulations, epidemiological profiles, AIDS treatment guidelines, and differing capacities to produce drugs locally.

Objectives. We conducted a large, population-based study to assess tobacco use in California's lesbian, gay, and bisexual (LGB) population. Methods. Standard measures of tobacco use from 2 separate, statewide household-based studies were used to compare basic prevalence rates in the LGB population and the general population in California. Data were derived from a 2003-2004 survey of LGB individuals living in California as well as from the 2002 version of the California Tobacco Survey, which gathered data on the state's general population. Results. Smoking prevalence rates were higher in our sample of lesbians, bisexual women, and women who have sex with women than among women in the general California population. In the case of men, the only significant difference was that rates were higher among gay men than among men in the general population. Disparities in tobacco use between the LGB population and the general population were still evident after we controlled for key demographic variables and in comparisons with other tobacco use indicators such as average cigarette consumption. Conclusions. Tobacco control efforts targeting the LGB population are needed to reduce this group's high rate of cigarette smoking. (Am J Public Health. 2007; 97:1496-1502. doi: l0.2105/AJ PH.2006.090258)

Botswana has the second highest HIV prevalence rate and highest rate of orphanhood in the world. Although child mortality rates have doubled in 15 years, the extent to which health disparities are connected to orphan status remains unclear. We conducted an analysis of the 2000 Botswana Multiple Indicator Cluster Survey to examine whether orphan-based health disparities exist. We measured health inequalities using anthropometric data among 2723 under-five year olds, nested in 1854 households, and 208 communities. We calculated multilevel logistic regression models to estimate the child, household, and regional determinants of growth failure. We found that orphaned children aged 0-4 are 49% more likely to be underweight than nonorphans (p Throughout sub-Saharan Africa (SSA), Botswana is a leader in responding to the AIDS epidemic, in particular as one of the first countries to offer universal antiretroviral treatment. However, orphan-based health disparities confirm that the orphan response is still insufficient. Better data are needed to fully understand the mechanisms that lead to these disparities, and the public sector needs an increased capacity to fully implement the policies and programs designed to meet the needs of orphans. Findings from this study have important implications for countries throughout SSA, and Southern Africa in particular, where the number of orphans has doubled to tripled over the past 15 years. Keywords: Child health; AIDS; Orphans; Human rights; Multilevel; Policy; Botswana

Objectives. Botswana has one of the world's highest HIV-prevalence rates and the world's highest percentages of orphaned children among its population. We assessed the ability of income-earning households in Botswana to adequately care for orphans. Methods. We used data from the Botswana Family Health Needs Study (2002), a sample of 1033 working adults with caregiving responsibilities who used public services, to assess whether households with orphan-care responsibilities encountered financial and other difficulties. Thirty-seven percent of respondents provided orphan care, usually to extended family members. We applied logistic regression models to determine the factors associated with experiencing problems related to orphan caregiving. Results. Nearly half of working households with orphan-care responsibilities reported experiencing financial and other difficulties because of orphan care. Issues of concern included caring for multiple orphans, caring for sick adults and orphans simultaneously, receiving no assistance, and low income. Conclusions. The orphan crisis is impoverishing even working households, where caregivers lack sufficient resources to provide basic needs. Neither the public sector nor communities provide adequate safety nets. International assistance is critical to build capacity within the social welfare infrastructure and to fund community-level activities that support households. Lessons from Botswana's orphan crisis can provide valuable insights to policymakers throughout sub-Saharan Africa.

Research indicates that lesbians who frequent bars are more likely to drink and that lesbians drink more than their heterosexual counterparts. We explored in detail the consequences of lesbians' bar attendance. We conducted 35 in-person, semi-structured interviews and analyzed the data using qualitative methods. The findings are organized into the following categories: safety and support over the life course: lesbian identity development: reduction of stress: and social networks and intimate relationships. In each category, participants' stories are presented to highlight the health tradeoffs associated with bar patronage, the psychosocial importance of the bar, and the relationship between minority stress and alcohol use. Public health implications are discussed. doi: 10.1300/J013v44n02_06 KEYWORDS. Alcohol, bars, lesbians, alcohol problems, substance abuse

This paper employs qualitative methods to explore the ramifications of a police drug crackdown on drug injectors' ability to practice harm reduction. Between August and December 2000, we conducted open-ended interviews with 40 illicit-drug-injecting residents of a New York City police precinct undergoing a crackdown. Interview topics included participants' experiences with police in the precinct and their drug use practices. Grounded theory methods were used to analyze resulting transcripts. Because place emerged as a salient analytic category, we also drew on elements of social geography to interpret results. The analysis suggests that particular crackdown tactics, notably frequent police searches of participants' bodies and elevated surveillance of the precinct's public spaces, reconfigured participants' experiences of their bodies and the public spaces comprising the precinct in ways that adversely affected their capacity to engage in harm reduction. Frequent police searches, for example, discouraged participants from carrying the injection equipment they needed to ensure that they could inject with a sterile syringe. Constant monitoring of local public spaces made it difficult for homeless women and men to inject safely. Simultaneously, participants expressed support for police actions that reduced public drug activity. Given these findings, we recommend the implementation of strategies, designed by partnerships of community groups and governmental and non-governmental organizations, which reduce public drug activity without imperiling injectors' health. Possible strategies include improving access to treatment and establishing safe injection spaces. Keywords: Law enforcement; Substance-related disorders; Social geography; Qualitative methods; Social inequality; USA

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2004.12.030 Byline: Hannah Cooper (a), Lisa Moore (b), Sofia Gruskin (c), Nancy Krieger (d) Keywords: Law enforcement; Substance-related disorders; Social geography; Qualitative methods; Social inequality; USA Abstract: This paper employs qualitative methods to explore the ramifications of a police drug crackdown on drug injectors' ability to practice harm reduction. Between August and December 2000, we conducted open-ended interviews with 40 illicit-drug-injecting residents of a New York City police precinct undergoing a crackdown. Interview topics included participants' experiences with police in the precinct and their drug use practices. Grounded theory methods were used to analyze resulting transcripts. Because place emerged as a salient analytic category, we also drew on elements of social geography to interpret results. The analysis suggests that particular crackdown tactics, notably frequent police searches of participants' bodies and elevated surveillance of the precinct's public spaces, reconfigured participants' experiences of their bodies and the public spaces comprising the precinct in ways that adversely affected their capacity to engage in harm reduction. Frequent police searches, for example, discouraged participants from carrying the injection equipment they needed to ensure that they could inject with a sterile syringe. Constant monitoring of local public spaces made it difficult for homeless women and men to inject safely. Simultaneously, participants expressed support for police actions that reduced public drug activity. Given these findings, we recommend the implementation of strategies, designed by partnerships of community groups and governmental and non-governmental organizations, which reduce public drug activity without imperiling injectors' health. Possible strategies include improving access to treatment and establishing safe injection spaces. Author Affiliation: (a) Medical Health and Research Institution/National Development and Research Institutes, Inc., 71 West 23rd Street, 8th Floor, New York 10010, USA (b) Department of Health Education, San Francisco State University, USA (c) Department of Population and International Health, Harvard School of Public Health, USA (d) Department of Society, Human Development, and Health, Harvard School of Public Health, USA

Despite growing recognition of violence's health consequences and the World Health Organization's recent classification of police officers' excessive use of force as a form of violence, public health investigators have produced scant re search characterizing police-perpetrated abuse, Using qualitative data from a study of a police drug crackdown in 2000 in 1 New York City police precinct, we explored 40 injection drug using and 25 non drug using precinct residents' perceptions of and experiences with police-perpetrated abuse. Participants, particularly injection drug users and non drug using men, reported police physical, psychological, and sexual violence and neglect; they often associated this abuse with crackdown related tactics and perceived officer prejudice. We recommend that public health research address the prevalence, nature, and public health implications of police violence.

Voir page 543 le resume en francais. En la pagina 543 figura un resumen en espanol. Introduction Approaches focusing on poverty, equity, or human rights in relation to health have [...], Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector. Keywords Health status; Poverty; Social justice; Human rights; Health services accessibility/ethics; Health care sector/organization and administration; Public policy; Intersectoral cooperation (source: MeSH, NLM). Mots cles Etat sanitaire; Pauvrete; Justice sociale; Droits homme; Accessibilite service sante/ethique; Secteur soins/organisation et administration; Politique gouvernementale; Cooperation intersectorielle (source: MeSH, INSERM). Palabras clave Estado de salud; Pobreza; Justicia social; Derechos humanos; Accesibilidad a los servicios de salud/etica; Sector de atencion de salud/organizacion y administracion; Politica social; Cooperacion intersectorial (fuente: DeCS, BIREME). Bulletin of the World Health Organization 2003;81:539-545.

In the past few years, US federal agencies governing research with human subjects and institutional review boards have taken a higher-profile path than ever before, both at home and internationally. This trend carries profound significance for US-based institutions and has implications also for the rest of the world. What does this critical moment of heightened federal scrutiny mean for the workings of US institutional review boards? We examined board activity across 3 dimensions: time, place, and consciousness. We conclude that although institutions in all areas of biomedical and social science research are adapting their practices, the field of public health is especially well positioned to adapt to, and succeed in, new efforts to ensure protection of human research subjects.

The Z-DNA-forming sequences in the SV40 enhancer were investigated using DNA minicircles which were synthesized as relaxed circles and then supercoiled by incremental treatment with topoisomerase I in the presence of ethidium bromide. The resulting topoisomers were then resolved by gel electrophoresis. The results showed that enhancer-containing minicircles have a superhelix density of -0.05.

To the Editor: In 'Charting the Future: Credentialing, Privileging, Quality, and Evaluation in Clinical Ethics Consultation' (Nov-Dec 2009), Nancy Dubler and colleagues aptly and accurately indict clinical ethics consultants, or [...]

To the Editor: John Arras and Elizabeth Fenton are, it seems, trying to write a provocative piece ('Bioethics and Human Rights: Access to Health-Related Goods,' Sept-Oct 2009). Sharp digs at [...]

Introduction Realization of the sexual and reproductive health (SRH) of women living with HIV remains a key challenge, in part due to a lack of integration of human rights in [...], Introduction: Even as the number of women living with HIV around the globe continues to grow, realization of their sexual and reproductive health and human rights remains compromised. The objective of this study was to review the current state of knowledge on the sexual and reproductive health and human rights of women living with HIV to assess evidence and gaps. Methods: Relevant databases were searched for peer?reviewed and grey literature. Search terms included a combination of MeSH terms and keywords representing women, HIV/AIDS, ART, human rights, sexual and reproductive health. We included both qualitative and quantitative literature published in English, French, or Spanish between July 2011 and December 2014. Results and discussion: The search yielded 2228 peer?reviewed articles, of which 40 met the inclusion criteria in the final review. The grey literature search yielded 2186 documents of which seven met the inclusion criteria in the final review. Of the articles and documents reviewed, not a single peer?reviewed article described the explicit implementation of rights in programming, and only two documents from the grey literature did so. With one possible exception, no articles or documents were found which addressed rights comprehensively, or addressed the majority of relevant rights (i.e. equality; non?discrimination; participation; privacy and confidentiality; informed decision making; availability, accessibility, acceptability and quality (3AQ) of services individually or in their totality; and accountability). Additional findings indicate that the language of rights is used most often to describe the apparent neglect or violation of human rights and what does exist only addresses a few rights in the context of a few areas within sexual and reproductive health. Conclusions: Findings from this review suggest the need to better integrate rights into interventions, particularly with attention to provider training, service delivery, raising awareness and capacity building among the community of women living with HIV. Further research is urgently needed to support the sexual and reproductive health and rights of women living with HIV, to identify what works and to inform future programming and policies to improve care, treatment and support for women living with HIV.

Introduction Realization of the sexual and reproductive health (SRH) of women living with HIV remains a key challenge, in part due to a lack of integration of human rights in [...], Introduction: Even as the number of women living with HIV around the globe continues to grow, realization of their sexual and reproductive health and human rights remains compromised. The objective of this study was to review the current state of knowledge on the sexual and reproductive health and human rights of women living with HIV to assess evidence and gaps. Methods: Relevant databases were searched for peer-reviewed and grey literature. Search terms included a combination of MeSH terms and keywords representing women, HIV/AIDS, ART, human rights, sexual and reproductive health. We included both qualitative and quantitative literature published in English, French, or Spanish between July 2011 and December 2014. Results and discussion: The search yielded 2228 peer-reviewed articles, of which 40 met the inclusion criteria in the final review. The grey literature search yielded 2186 documents of which seven met the inclusion criteria in the final review. Of the articles and documents reviewed, not a single peer-reviewed article described the explicit implementation of rights in programming, and only two documents from the grey literature did so. With one possible exception, no articles or documents were found which addressed rights comprehensively, or addressed the majority of relevant rights (i.e. equality; non-discrimination; participation; privacy and confidentiality; informed decision making; availability, accessibility, acceptability and quality (3AQ) of services individually or in their totality; and accountability). Additional findings indicate that the language of rights is used most often to describe the apparent neglect or violation of human rights and what does exist only addresses a few rights in the context of a few areas within sexual and reproductive health. Conclusions: Findings from this review suggest the need to better integrate rights into interventions, particularly with attention to provider training, service delivery, raising awareness and capacity building among the community of women living with HIV. Further research is urgently needed to support the sexual and reproductive health and rights of women living with HIV, to identify what works and to inform future programming and policies to improve care, treatment and support for women living with HIV. Keywords: human rights; sexual health; reproductive health; women living with HIV; healthcare.

Introduction The advent of antiretroviral therapy (ART) was meant to change the course of the AIDS epidemic. In many ways it did: there was a dramatic reduction in AIDS-related morbidity [...], Introduction: This article seeks to identify where delays occur along the adult HIV care cascade ("the cascade"), to improve understanding of what constitutes "delay" at each stage of the cascade and how this can be measured across a range of settings and to inform service delivery efforts. Current metrics are reviewed, measures informed by global guidelines are suggested and areas for further clarification are underscored. Discussion: Questions remain on how best to evaluate late entry into each stage of the cascade. The delayed uptake of HIV testing may be more consistently measured once rapid CD4 testing is administered at the time of HIV testing. For late enrolment, preliminary research has begun to determine how different time intervals for linking to HIV care affect individual health. Regarding treatment, since 2013, the World Health Organization (WHO) and UNAIDS recommend treatment initiation when CD4 Conclusions: There is no "one size fits all" model as the provision of services may differ based on a range of factors. Nonetheless, measures informed by global guidelines are needed to more consistently evaluate the scope of and factors associated with delays to each stage of the cascade. Doing so will help identify how practitioners can best deliver services and facilitate access to and continued engagement in care. Keywords: HIV/AIDS; care cascade; treatment cascade; continuum of care; testing; linkage to care; viral suppression; measures.

Introduction Integrating legal support into health services is an important strategy for enabling people who are socially marginalized to access justice and address human rights violations that undermine their health [...], Introduction: In Kenya, human rights violations have a marked impact on the health of people living with HIV. Integrating legal literacy and legal services into healthcare appears to be an effective strategy to empower vulnerable groups and address underlying determinants of health. Methods: We carried out an evaluation to collect evidence about the impact of legal empowerment programmes on health and human rights. The evaluation focused on Open Society Foundation-supported legal integration activities at four sites: the Academic Model of Providing Access to Healthcare (AMPATH) facility, where the Legal Aid Centre of Eldoret (LACE) operates, in Eldoret; Kenyatta National Hospital's Gender-based Violence Recovery Centre, which hosts the COVAW legal integration program; and Christian Health Association of Kenya (CHAK) facilities in Mombasa and Naivasha. In consultation with the organizations implementing the programs, we designed a conceptual logic model grounded in human rights principles, identified relevant indicators and then coded structure, process and outcome indicators for the rights-related principles they reflect. The evaluation included a resource assessment questionnaire, a review of program records and routine data, and semi-structured interviews and focus group discussions with clients and service providers. Data were collected in May-August 2010 and April-June 2011. Results: Clients showed a notable increase in practical knowledge and awareness about how to access legal aid and claim their rights, as well as an enhanced ability to communicate with healthcare providers and to improve their access to healthcare and justice. In turn, providers became more adept at identifying human rights violations and other legal difficulties, which enabled them to give clients basic information about their rights, refer them to legal aid and assist them in accessing needed support. Methodological challenges in evaluating such activities point to the need to strengthen rights-oriented evaluation methods. Conclusions: Legal empowerment programmes have the potential to promote accountability, reduce stigma and discrimination and contribute to altering unjust structures and systems. Given their apparent value as a health and human rights intervention, particularly for marginalized populations, further rigorous evaluations are called for to support the scale-up of such programmes. Keywords: HIV; AIDS; human rights; programme evaluation; public health; stigma; discrimination. To access the appendices to this article please see Supplementary Files under Article Tools online.

Introduction There is increasing attention to 'structural barriers' in the HIV literature and to the ways these inhibit the effectiveness of HIV responses at national and local levels. Despite the [...], Introduction: Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses. Methods: Law and policy data from the 171 countries reporting under the Declaration of Commitment from the 2001 United Nations General Assembly Special Session on HIV/AIDS were analyzed to assess attention to human rights in national legal and policy environments as relevant to the health and rights of key populations such as people who inject drugs, men who have sex with men and sex workers. Results: Seventy-eight governments and civil society in 106 countries report the existence of laws and policies which present obstacles to accessing HIV services for key populations. Laws and policies which positively affect access to HIV-related services, in and of themselves constituting structural interventions, were also reported. The dissonance between laws and how this impacts the availability and use of HIV-related services deserve greater attention. Conclusions: Recognition of the harms inherent in laws that constitute structural barriers to effective HIV responses and the potential positive role that a supportive legal environment can play suggests the need for legal reform to ensure an enabling regulatory framework within which HIV services can be effectively delivered and used by the populations who need them. Moving beyond laws and policies, further efforts are required to determine how to capture information on the range of structural barriers. Teasing apart the impact of different barriers, as well as the structural interventions put in place to address them, remains complicated. Capturing the impact of policy and legal interventions can ultimately support governments and civil society to ensure the human rights of key populations are protected in national HIV responses. Keywords: AIDS; HIV; human rights; key populations; law; policy; structural barriers.

Introduction There is increasing attention to ?structural barriers? in the HIV literature and to the ways these inhibit the effectiveness of HIV responses at national and local levels. Despite the [...], Introduction: Attention to the negative effects of structural barriers on HIV efforts is increasing. Reviewing national legal and policy environments with attention to the international human rights commitments of states is a means of assessing and providing focus for addressing these barriers to effective HIV responses. Methods: Law and policy data from the 171 countries reporting under the Declaration of Commitment from the 2001 United Nations General Assembly Special Session on HIV/AIDS were analyzed to assess attention to human rights in national legal and policy environments as relevant to the health and rights of key populations such as people who inject drugs, men who have sex with men and sex workers. Results: Seventy?eight governments and civil society in 106 countries report the existence of laws and policies which present obstacles to accessing HIV services for key populations. Laws and policies which positively affect access to HIV?related services, in and of themselves constituting structural interventions, were also reported. The dissonance between laws and how this impacts the availability and use of HIV?related services deserve greater attention. Conclusions: Recognition of the harms inherent in laws that constitute structural barriers to effective HIV responses and the potential positive role that a supportive legal environment can play suggests the need for legal reform to ensure an enabling regulatory framework within which HIV services can be effectively delivered and used by the populations who need them. Moving beyond laws and policies, further efforts are required to determine how to capture information on the range of structural barriers. Teasing apart the impact of different barriers, as well as the structural interventions put in place to address them, remains complicated. Capturing the impact of policy and legal interventions can ultimately support governments and civil society to ensure the human rights of key populations are protected in national HIV responses.

This is the first of three viewpoints examining the question of whether pharmaceutical companies are living up to their human rights responsibilities. The Right to Health and Essential Medicines Debate [...], Background to the debate: The human rights responsibilities of drug companies have been considered for years by nongovernmental organizations, but were most sharply defined in a report by the UN Special Rapporteur on the right to health, submitted to the United Nations General Assembly in August 2008. The "Human Rights Guidelines for Pharmaceutical Companies in relation to Access to Medicines" include responsibilities for transparency, management, monitoring and accountability, pricing, and ethical marketing, and against lobbying for more protection in intellectual property laws, applying for patents for trivial modifications of existing medicines, inappropriate drug promotion, and excessive pricing. Two years after the release of the Guidelines, the PLoS Medicine Debate asks whether drug companies are living up to their human rights responsibilities. Sofia Gruskin and Zyde Raad from the Harvard School of Public Health say more assessment is needed of such responsibilities;Geralyn Ritter, Vice President of Global Public Policy and Corporate Responsibility at Merck & Co. argues that multiple stakeholders could do more to help States deliver the right to health;and Paul Hunt and Rajat Khosla introduce Mr. Hunt&apos;s work as the UN Special Rapporteur on the right to the highest attainable standard of health, regarding the human rights responsibilities of pharmaceutical companies and access to medicines.

Objectives. This study compared the prevalence of cigarette smoking and alcohol use among lesbians and bisexual women with that among heterosexual women Methods. Logistic regression models were created with data from an extensive member health survey at a large health maintenance organization. Sexual orientation was the primary predictor, and alcohol consumption and cigarette smoking were outcomes. Results. Lesbians and bisexual women younger than 50 yearn were more likely than heterosexual women to smoke cigarettes and drink heavily. Lesbians and bisexual women aged 20 to 34 reported higher weekly alcohol consumption and less abstinence compared with heterosexual women and older lesbians and bisexual women. Conclusions. Lesbians and bisexual women aged 20 to 34 years are at risk for alcohol use and cigarette smoking. (Am J Public Health. 2001;91: 976-979)

The report of the Pediatric Subspecialists of the Future Workgroup of the Second Task Force on Pediatric Education reviews the critical changes of the past 2 decades that have affected the provision of pediatric subspecialty services, education of pediatric health care providers, and the acquisition and application of new knowledge. The report considers the future needs that will determine the ability of pediatric subspecialists to meet identified goals. Recommendations for change in the education, role, and financing of the pediatric subspecialist are reported together with those of other workgroups. Pediatrics 2000;106(suppl):1224-1244; pediatric subspecialist, pediatric subspecialist workforce, education pediatric subspecialist, research pediatric subspecialist.