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Extreme forms of weather are predicted to become more frequent experiences in the future. However, the hardest event to mitigate against is the unexpected. In the UK, the occurrence of winter snowfall is difficult to predict, highly variable, both spatially and temporally and predicted to become less common in the future. This paper examines the consequences of the severe winter of 1946/1947 at the local scale through a Welsh case study of Cwm Tywi, a community of upland sheep farms. This community had shown great resilience during the snowiest winter on record in comparison with other, more urban communities, but the inhabitants eventually abandoned their homes because of the emotional distress caused by the loss of a large proportion of the livestock. In addition to the severity of the snow, perceptions of the extreme nature of this event and the community's ability to mitigate as a result of rurality, self-sufficiency and remoteness are investigated through the analysis of interviews, oral histories, and other documentary accounts. This case study provides an insight into the complexity of understanding vulnerability, adaptation and resilience, which are temporally and spatially specific. [ABSTRACT FROM AUTHOR]

Objectives: To examine trends in rates of diagnoses of HIV and other sexually transmitted infections (STIs) in men who have sex with men (MSM) in England and Wales between 1997 and 2002., Methods: Estimates of the MSM population living in England and Wales, London and the rest of England and Wales were applied to surveillance data, providing rates of diagnoses of HIV and STIs and age group specific rates for HIV and uncomplicated gonorrhoea., Results: Between 1997 and 2002, rates of diagnoses of HIV and acute STIs in MSM increased substantially. Rates in London were higher than elsewhere. Rises in acute STIs were similar throughout England and Wales, except for uncomplicated gonorrhoea and infectious syphilis, with greater increases outside London. Rates of gonorrhoea diagnoses doubled between 1999 and 2001 (661/100,000, 1271/100,000, p<0.001) in England and Wales followed by a slight decline to 1210/100,000 (p=0.03) in 2002-primarily the result of a decline in diagnoses among men aged 25-34 (1340/100,000, 1128/100,000, p<0.001) and 35-44 (924/100,000, 863/100,000, p=0.03) in London. HIV was the third most common STI diagnosed in MSM in England and Wales and the second in London, with the highest rate (1286/100,000) found among men aged 35-44 in London in 2002., Conclusions: Rates of diagnosis of HIV and other STIs have increased substantially among MSM in England and Wales. Increases show heterogeneity by infection, geography, and age over time. Rates in London were twice those seen elsewhere, with greatest changes over time. The observed changes reflect concomitant increases in high risk behaviour documented in behavioural surveillance survey programmes.

Using data from the annual surveys of individuals receiving HIV related treatment or other care from 1996 to 2000, trends in prevalent numbers of diagnosed HIV infections have been extrapolated to the years 2001-05. Results show that the adjusted prevalent number for 1996 was 14,205 and that this has increased by 62% by the end of 2000, and will have increased by 139% by the end of 2005. The drivers for this increase have been the sustained rise in diagnoses in infections heterosexually acquired in sub-Saharan Africa and the continuing numbers of new diagnoses in men who have sex with men.

A profile of sexually transmitted diseases (STDs) and HIV infections among teenagers in England and Wales was obtained from reports of newly diagnosed STDs among teenagers attending genitourinary medicine (GUM) clinics in 1995, laboratory reports of newly diagnosed HIV infections between 1985 when reporting began and the end of 1995, and the prevalence of HIV (unlinked anonymous programme) among teenagers attending genitourinary medicine clinics and antenatal clinics in 1994 and 1995. STD reports were analysed by sex, age group, and place of residence of patients--whether in the NHS Thames regions or elsewhere in England and Wales. High rates of STDs were reported in teenagers, particularly in girls. The incidences of gonorrhoea, chlamydia infection, and first attack genital wart infections were higher in teenage girls than in any other age group. Boys under 16 years of age had substantially higher rates of infection with all STDs in the Thames regions than elsewhere. Rates of gonorrhoea in teenagers of both sexes in the Thames regions were more than twice those in the rest of the country. Infection rates for genital herpes, and chlamydia in girls, were also higher in the Thames regions, although the geographical differences were less marked. The seroprevalence of HIV among heterosexual teenagers was very low. In contrast, 226 HIV infections among teenage boys had probably been acquired through sexual intercourse with other males. Unlinked anonymous testing revealed HIV antibody in 7.5% of routinely collected serology specimens taken from teenage homosexual or bisexual males attending GUM clinics in London. The high rates of STDs among teenage girls and all teenagers in the Thames regions make these groups a high priority for sexual health promotion, with special consideration given to homo/bisexual male teenagers. Detailed surveillance of risk factors for STDs, and further studies of teenage sexual behaviour will help to effectively target resources to improve the sexual health of teenagers in England and Wales.