Journal articles on the topic 'Malawi. National AIDS Commission'

Abstract 33 Background: Enabled by collaboration and political stability, Malawi is a global leader for HIV research and implementation. We undertook this work to identify ways to leverage successes in HIV treatment and research for cancer and noncommunicable diseases (NCDs). Methods: Over more than two decades, investment from the National Institutes of Health (NIH) and other funders has allowed Malawi participation in international HIV networks. As these sought to address HIV-positive cancer, investment occurred to increase pathology, improve cancer registration, scale up cervical cancer screening, and improve nursing and pharmacy skills for chemotherapy administration. This allowed Malawi to participate in multinational clinical trials for HIV-positive Kaposi sarcoma treatment and cervical cancer prevention. Building on this, Malawi was one of six countries in 2014 to receive an NIH U54 consortium award for HIV-positive malignancies and was one of six countries added to the National Cancer Institute (NCI) AIDS Malignancy Consortium. In 2016, expanding beyond HIV-positive cancer, Malawi was one of three countries invited to join a new NCI–International Agency for Research on Cancer esophageal cancer consortium, one of five recipients of a new NCI Burkitt lymphoma award, and one of six recipients of a new NCI P20 grant for a regional center of research excellence for NCDs. Malawi is also one of 11 countries to convene a Lancet noncommunicable diseases and injury poverty commission for NCDs and injury. Finally, partners have improved surveillance and treatment for hypertension, diabetes, injury, and sickle cell anemia, in part, through a national Knowledge Translation Platform for HIV-NCD integration. With this support and funding, career development opportunities are embedded for Malawian NCD researchers. Results: Building on successes in HIV treatment and research, Malawi has become a global leader for cancer and NCD research and implementation. Conclusion: Continue developing a multilateral national platform for NCD research and implementation that is globally impactful and can lead to measurable outputs for individual cancer and NCD focus areas. Funding: National Institutes of Health. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

The notion of fiscal aid is becoming crucial in determining the relationship between supra-national integration and national tax sovereignty; the selectivity criterion is often key in the assessment of compatibility of fiscal measures with Article 107(1) TFEU. Therefore, the notion of selectivity as defined by the recent case-law of the CJEU and decision-making practice of the Commission is fundamental in order to understand the actual allocation of powers in direct taxation matters. Against this backdrop, the aim of the present article is to establish what the current notion of selectivity is in fiscal aids, assessing whether the approach used by the CJEU and the Commission share common patterns, and evaluating the impact of such interpretation on the division of competences within the EU. In particular, this article offers a critical reading of the recent European Commission v. World Duty Free case and of the so-called Tax Rulings Decisions.

On 17 May, 1995, the Malawi National Assembly adopted a democratic constitution. In terms of Malawi’s post-colonial history, the adoption of the constitution was an unprecedented event. For a period of 30 years, Malawi had been subjected to a one-party dictatorship led by Dr Hastings Banda. Supported over the years by the West because of its anti-communist rhetoric, the Banda regime found itself abandoned with the ending of the Cold War and the collapse of apartheid in South Africa. Pressure from internal and external groups led to a referendum on the oneparty state in June 1993 which the Banda regime lost and to the first multi-party elections in May 1994 which the regime also lost. A day before the 1994 elections, the Malawi National Assembly adopted a Provisional Constitution for a period of 12 months. Pursuant to section 212 of the Provisional Constitution, the National Constitutional Conference was held in February 1995 for the purpose of making recommendations to the National Assembly on a permanent constitution. Rather than replace or repeal the Provisional Constitution, the National Assembly decided in April 1995 to make modest amendments to it in order to address some of the more blatant deficiencies that were identified at the Constitutional Conference. During the coming years, the Law Commission will make a detailed study of the entire document, make recommendations to the Minister of Justice and, it is hoped, address some of the obvious drafting oversights.

From February to June 1995 approximately 300,000 people attended an anti-AIDS healing cult in Malawi. The name given to the cult was mchape. The article investigates the so-called ‘mchape affair’ and compares it with the anti-witchcraft movements which swept Malawi during the 1930s under the very same name. Against the background of this linguistic identity, the article reflects on the politics of healing, social memory and the public sphere as the national space in which the affair assumed its distinctive shape. Focusing on the perception of AIDS as encoding decay, it is argued that the mchape affair can be understood as a negotiation of the limits of power and the meaning of suffering nourished by the moral imagination of post-Banda society.

Abstract 68 Background: Cancer burden is increasing in Malawi, particularly for HIV-associated malignancies. Methods: With support from the National Cancer Institute, the Malawi Cancer Consortium (MCC) was initiated in September 2014. Partners include the UNC Lineberger Comprehensive Cancer Center, Malawi Ministry of Health, University of Malawi College of Medicine, and Lighthouse Trust. Spanning Malawi’s two major cities, Lilongwe and Blantyre, MCC includes three support cores (administration, analysis, mentoring) and three multi-institution research projects: (1) a national HIV-cancer match study to assess cancer incidence in the ART era; (2) a longitudinal cohort to identify clinical and molecular correlates of KS chemotherapy response; and (3) a longitudinal cohort to elucidate lymphoma biology and develop better treatments for HIV-associated lymphoma. Results: For project 1, 65,500 records from the Malawi National Cancer Registry and Malawi HIV cohorts have been abstracted, and initial data harmonization completed. Record linkage is planned for February 2016, will be updated at regular intervals, and will contribute to regional analyses through the IeDEA- Southern Africa network. For project 2, KS studies through MCC have led to descriptions of KS biologic subtypes defined by viral gene expression profiling, and detailed characterization of multicentric Castleman disease. Malawi has also led enrollment into multinational phase III KS clinical trials implemented by the AIDS Clinical Trials Group and AIDS Malignancy Consortium. For project 3, more than 300 adults and children with lymphoma have been enrolled since June 2014, with approximately 2/3 of adults being HIV-infected. Patients receive standardized treatment and supportive care, and standardized clinical and laboratory evaluations. Specimen-based correlative studies (virologic, genomic, biomarker studies) are ongoing. Finally, the consortium provides a platform for pilot studies in breast and esophageal cancer, and facilitates career development for Malawian cancer investigators. Conclusions: MCC has initiated a national coalition to address cancer in Malawi, and continued progress is anticipated. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Sam Phiri No relationship to disclose Joe Gumulira No relationship to disclose Hannock Tweya No relationship to disclose Lameck Chinula No relationship to disclose Agnes Moses No relationship to disclose Bongani Kaimila No relationship to disclose Christopher Stanley No relationship to disclose Edwards Kasonkanji No relationship to disclose Steady Chasimpha No relationship to disclose Richard Nyasosela No relationship to disclose Leo Masamba No relationship to disclose Tamiwe Tomoka No relationship to disclose Steve Kamiza No relationship to disclose Mina Hosseinipour No relationship to disclose Nora Rosenberg Research Funding: NIH/NCI Ron Mataya No relationship to disclose Charles Dzamalala No relationship to disclose George Liomba No relationship to disclose Irving Hoffman No relationship to disclose Dirk Dittmer No relationship to disclose Yuri Fedoriw Honoraria: Alexion Pharmaceuticals Blossom Damania No relationship to disclose Satish Gopal No relationship to disclose

Abstract Despite growing evidence of the significance of health literacy in managing and coping with acquired immune deficiency syndrome (HIV), it is not yet an integrated part of HIV/AIDS-related health promotion research and practice in Africa. This article contributes to addressing the gap in research on health literacy and HIV in Sub-Saharan Africa. We aimed to assess health literacy-related needs of young people living with HIV (YPLHIV) and adapt existing health literacy frameworks to the context of HIV/AIDS in Malawi. We used focus group discussions to collect data from a sample of the membership of the national association of YPLHIV. Twenty-four HIV-positive youth (18–29 years) participated in focus group discussions. Participants came from three regions of Malawi. Additionally, we conducted three in-depth interviews with key informants. We used a thematic framework approach to analyse data in MAXQDA. We contextualized definitions of four dimensions of health literacy: functional, interactive, critical and distributed health literacy, which we used as an a priori analytical framework. To further contextualize the framework, we revised it iteratively throughout the analysis process. We identified the need for comprehensive information about HIV and sexual reproductive health, skills to interact with healthcare providers and navigate the health system, and skills to appraise information from different sources, among others. The identified needs were translated into nine action recommendations for the national association of YPLHIV, and with relevance within the wider HIV sector in Malawi and beyond. We found that the dimensions in our analytical framework operate on the individual, system and public policy levels.

Although it is true that inmates in U.S. prisons are experiencing high rates of HIV disease, it also is true that incarceration affords a meaningful opportunity to prevent the spread of HIV/AIDS through education. Consequently, providing effective education programs for inmates is an important corrections and public health concern. In an attempt to assess our current efforts in this area, a survey of all 50 state departments of corrections was conducted. As part of that survey, descriptions of inmate AIDS education programs were obtained from 27 states. These programs were analyzed using themes garnered from a variety of published recommendations concerning effective AIDS education. The results of the content analysis for the 27 descriptions were then specifically compared with the National Commission on AIDS recommendations for AIDS education programs for inmates.

AbstractObjectiveTo investigate trends in child malnutrition in six countries in southern Africa, in relation to the HIV epidemic and drought in crop years 2001/2 and 2002/3.DesignEpidemiological analysis of sub-national and national surveys with related data.SettingData from Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe, compiled and analysed under UNICEF auspices.SubjectsSecondary data: children 0–5 years for weight-for-age; HIV prevalence data from various sources especially antenatal clinic surveillance.ResultsChild nutritional status as measured by prevalence of underweight deteriorated from 2001 onwards in all countries except Lesotho, with very substantial increases in some provinces/districts (e.g. from 5 to 20% in Maputo (Mozambique, 1997–2002), 17 to 32% in Copperbelt (Zambia, 1999–2001/2) and 11 to 26% in Midlands province (Zimbabwe, 1999–2002)). Greater deterioration in underweight occurred in better-off areas. Areas with higher HIV/AIDS prevalences had (so far) lower malnutrition rates (and infant mortality rates), presumably because more modern areas – with greater reliance on trade and wage employment – have more HIV/AIDS. Areas with higher HIV/AIDS showed more deterioration in child nutrition. A significant area-level interaction was found of HIV/AIDS with the drought period, associated with particularly rapid deterioration in nutritional status.ConclusionsFirst, the most vulnerable may be households in more modern areas, nearer towns, to whom resources need to be directed. Second, the causes of this vulnerability need to be investigated. Third, HIV/AIDS amplifies the effect of drought on nutrition, so rapid and effective response will be crucial if drought strikes again. Fourth, expanded nutritional surveillance is now needed to monitor and respond to deteriorating trends. Finally, with or without drought, new means are needed of bringing help, comfort and assistance to the child population.

Recent events have demonstrated the potential for catastrophic accidents at process control facilities, resulting in severe economic damages or loss of human life. Human operators play a central role in the outcome of accidents in process control plants, because of their responsibility to make decisions regarding the appropriate corrective actions needed to control the event. In recent years, researchers have been attempting to apply Artificial Intelligence (AI) methods for developing computer-based decision aids for process control operators. Much of this research activity has taken place within the nuclear industry. In order to assess the implications of expert systems for nuclear reactor operators, the United States Nuclear Regulatory Commission (USNRC) has sponsored a research program at the Idaho National Engineering Laboratory (INEL). Included in this program have been the development of a prototype expert system for nuclear reactor operators, as well as two experiments to measure the effects of the expert system on operator performance in simulated accident conditions. This paper briefly summarizes the experience gained during this research program and assesses the potential future of expert system decision aids for process control operators.

Abstract The past 5 years have seen incredible advances in approaching hearing loss as a major public health issue. National efforts include the 2015 President’ Council of Advisors on Science and Technology and the National Academies of Science, Engineering, & Medicine’s 2016 Commission on Hearing Health Care for Adults, which led to the 2017 OTC hearing aid legislation and the expected debut of OTC hearing aids in 2020-2021. The World Report on Hearing amplifies these efforts. This presentation will cover the role of the Report in the context of the rapidly evolving hearing care landscape in the US and how the Report’s call for affordable, accessible hearing care fit within current national efforts focused on older adults. Finally, the WHO recognized 2020-2030 as the Decade of Healthy Aging. We will discuss how the World Report on Hearing integrates with broader efforts to support healthy aging locally and globally.

Forensic science is at a crossroads. In the last two decades, often-used forms of pattern evidence, such as fingerprint, tool mark, and bite mark identification, have faced significant criticism for lacking adequate scientific validation or proven reliability. Is this the beginning of a sea change, signaling the rise of a science-based, empirically grounded approach to these forms of evidence, both in the courtroom and in the crime laboratory? Or has the increased attention produced Band-Aids rather than meaningful and lasting cures? This essay argues that the current state of forensic science reform is both “half empty” and “half full.” Looking first at bite mark evidence, then at modifications in the language used by forensic scientists for their courtroom testimony, and, finally, at the creation and the elimination of the National Commission on Forensic Science, this essay argues that we have thus far seen modest and meaningful – but far from adequate or transformative – reform. Our best hope for sustained, substantial changes necessary for improving forensic science evidence within our system of justice requires the creation of another national commission or other institutional body, made up of both research scientists and other institutional stakeholders, and situated as to prevent “capture” by either forensic practitioners or advocates within our adversarial system.

The Indonesian government established the prevalence target of HIV <0.50% in 2019 to control the spreading of HIV through the National Medium Term Development Plan. To ensure the sustainability of this development plan, a study of the strategic capacity of HIV/AIDS programmes is needed to provide an overview so that the program can be sustained over time. This study aimed to explore the sustainability capacity of HIV/AIDS programmes in Yogyakarta. This was a descriptive study utilizing a qualitative approach. The study involved 42 participants as key informants selected by a purposive sampling technique, and the data were examined using content analysis. By setting priorities of the local government supported by the Provincial Health Office and with the coordination of the Yogyakarta Province AIDS Commission, the programs are able to maintain sustainable HIV and AIDS programmes in Yogyakarta. Funding capacity, evaluation, programme adaptation and communication have not been optimal to ensure the sustainability. Stability of funding is the main obstacle to achieving the sustainability of HIV and AIDS programs. However, with good planning, partnership structure and sufficient organizational capacity, this approach can ensure the HIV and AIDS programmes will continue with the targets set by the Yogyakarta Provincial Health Office. The government in Yogyakarta needs to increase funding capacity, and improve communication to ensure sustainability. The strategy should include adaptation and evaluation of programs through strengthening private sector financing, formulating a communication plan and improving the capacity to respond to change.

Background: Many lower and middle income countries (LMICs) have high levels of linguistic diversity, meaning that health information and care is not available in the languages spoken by the majority of the population. This research investigates the extent to which language needs are taken into account in planning for HIV/AIDS-related health communication in development contexts. Methods: We analysed all HIV/AIDS-related policy documents and reports available via the websites of the Department for International Development UK, The Global Fund, and the Ministries of Health and National AIDS commissions of Burkina Faso, Ghana and Senegal. We used quantitative and qualitative analysis to assess the level of prominence given to language issues, ascertain the level at which mentions occur (donor/funder/national government or commission), and identify the concrete plans for interlingual communication cited in the documents. Results: Of the 314 documents analysed, 35 mention language or translation, but the majority of the mentions are made in passing or in the context of providing background socio-cultural information, the implications of which are not explored. At donor level (DFID), no mentions of language issues were found. Only eight of the documents (2.5%) outline concrete actions for addressing multilingualism in HIV/AIDS-related health communication. These are limited to staff training for sign language, and the production of multilingual resources for large-scale sensitization campaigns. Conclusions: The visibility of language needs in formal planning and reporting in the context of HIV/AIDS-related health care is extremely low. Whilst this low visibility should not be equated to a complete absence of translation or interpreting activity on the ground, it is likely to result in insufficient resources being dedicated to addressing language barriers. Further research is needed to fully understand the ramifications of the low prominence given to questions of language, not least in relation to its impact on gender equality.

Researchers, scientists, and physicians in Uganda have become increasingly aware of the need to develop a systematic approach to reviewing bio-medical research conducted in their country. Much of this awareness and their concern stems from Uganda's high seroprevalence of human immunodeficiency virus (HIV) and the consequent large influx of research monies and HIV researchers from developed countries, including the United States and Great Britain.We report on the proceedings of a five-day symposium on bioethical principles governing clinical trials, which convened in Jinja, Uganda in September 1994. The thirteen male and female workshop participants included representatives from the Uganda Ministry of Health, Makerere University, the Uganda AIDS Commission, Uganda's National Council of Science and Technology, and the National Chemotherapeutic Laboratory. These representatives included ethicists, physicians, researchers, and pharmacists, all of whom have conducted research themselves. Initial workshop sessions focused on the history of human experimentation and the development of protections for human participants in medical research, both in the United States and internationally.

HIV/AIDS prevention is very important and absolutely necessary. HIV transmission is now entering a fairly alarming level, in which people with HIV/AIDS in certain subpopulations are emerging. Special steps and resources are thus needed to cope with the condition. There are some phenomena potentially encourage HIV transmissions, such as the increasingly common free sex, homosexuality, the use of unsafe and unsterile syringes in narcotics consumption, commercial sex workers and various high-risk sexual activities. One of the crucial concerns that arises when sending prostitutes back to their hometowns without any coordinated and holistic mechanism is that the prostitutes may cause the spreading of HIV/AIDS in their hometowns. The research objective is to provide the material (input) how the prostitutes themselves may cause the spreading of HIV/AIDS. The research employed descriptive method with a qualitative approach. The results showed that the implementation and the role division in the closure have been highly coordinated and holistic. The leading sector in the role division is the Social Welfare epartment of the Government in Surabaya. In terms of health aspects for the former prostitutes sent back to their hometowns, there has been no policies related to medical screening designed to identify the disease early. Screening is very important for early diagnosis during the post-closure phase. The screening mechanism is that the Provincial Health Department has to optimize the monitoring, coordination, cooperation, agreements and partnerships with stakeholders such as the Local Health Department and the National/Provincial/Distric AIDS Commission, NGOs that are concerned with the problems of HIV-AIDS, international organizations, professional organizations, community leaders, religious leaders and universities.

Official data from the National AIDS Commission (KPA) showed that East Java ranks 2 (two) for most HIV. Whereas Pasuruan Regency was ranked as number 2 (two) the most cases of HIV and AIDS from all Regencies in East Java with 984 cases starting from 2000-2016. The majority of HIV cases were dominated by productive age (adolescents) between the ages of 20-29 years, the number of which reached around 300 people or around 32%. of the total HIV cases in Pasuruan Regency (KPA data of Pasuruan from 2000-2016). While in terms of data on HIV distribution by region, Prigen Subdistrict was ranked first with 82 cases. Responding to the issue, the role of the Faith Based Organization (FBO) was based on youth through the active role of Young Relegious Leader in Prigen Pasuruan was very encouraged to participate in HIV & AIDS prevention especially in adolescents. To support and strengthen the role of FBO in prevention of HIV and AIDS through efforts: to increase capacity building and knowledge of young religious leader on HIV and AIDS in medical and religion perspective, strengthening communication skills in social campaigns through the use of video blog media (VLOG), making HIV (AIDS) prevention materials (Modules) and building related partnership networks. The institutional strengthening of FBO was focused on Youth-Based FBO in Prigen Pasuruan which included Nahdlatul Ulama' (IPNU & IPPNU) Student Association, Muhammadiyah Youth Association (IPM) and representatives from Christian Youth in Prigen Pasuruan. Through strengthening this role, it was expected that the FBO would be able to prevent HIV/AIDS in members/congregations in their respective organizations in planned and independent manner. In addition, strengthening the role of FBO would also be a new movement of FBO in ​​Tretes Prigen area in taking responsibility for HIV and Narcotics issues in adolescents.

The article seeks to advance understanding of the involvement of transnational student associations in European governance of higher education policies within the European Union (EU) and the European Higher Education Area (EHEA). Specifically, the article explores the mechanisms for interest intermediation that exist for transnational student associations in both policy arenas. Three transnational student associations stand out in terms of their involvement: European Students’ Union (ESU), Erasmus Student Network (ESN) and European Students’ Forum (AEGEE). The findings point to two distinct models of student interest intermediation in European policy-making. Within the EU, the European Commission interacts with all three transnational student associations; however, ESU and ESN participate in more expert and working groups. The roles afforded to each association in relation to the European Commission are demarcated and functionally differentiated. Within EHEA, in neo-corporatist fashion, ESU, as a representative platform of national student unions, holds representational monopoly. In the EHEA and the EU, the involvement of transnational student associations in policy-making can be attributed to the evolving nature of transnational governance regimes in which participation of transnational student associations not only brings expertise to but also aids the legitimacy of the policy processes and outcomes.

IntroductionDolutegravir-based antiretroviral therapy (ART) is increasingly being used as the preferred first-line regimen for the treatment of HIV in low-income and middle-income countries. The National Program for the Control of STI/HIV/AIDS in Mozambique has planned a phased introduction of the tenofovir/lamivudine/dolutegravir (TLD) regimen. In 2019, concerns about a potential safety signal identified with dolutegravir identified in the results of the Tsepamo study, conducted in Botswana, led the National Directorate of Pharmacy and the National Program for the Control of STI/HIV/AIDS to establish an active pharmacovigilance surveillance system among newly placed patients on a TLD regimen. This activity aims to establish an active pharmacovigilance system to monitor adverse events in patients on a TLD regimen to support the effectiveness of Mozambique’s public health programmes in improving the process of care and treatment outcomes for people with HIV/AIDS.Methods and analysisThis is a prospective, non-interventional, descriptive cohort study to monitor HIV patients managed with TLD at 10 sentinel health centres in Mozambique. The cohort consists of HIV-infected patients commencing treatment with TLD, either as treatment naïve patients or switched from other ART regimens. Patients have monthly routine follow-up visits for the first 3 months after starting HIV treatment with TLD, and subsequently every 3 months for a total period of 1 year. Patients are monitored to identify possible adverse events during the follow-up period. The intended size of the cohort is 3000 patients.Ethics and disseminationEthical approval was obtained from the National Commission on Bioethics in Health in Mozambique. Written informed consent is obtained from each participant who agrees to participate to have their information collected, analysed and stored. Findings will be reported to the Ministry of Health and participating health centres to inform policy and practice as well as disseminated by peer-review publications.

AbstrakDi tingkat nasional dan daerah telah terdapat kebijakan publik, program dan kegiatan untuk menanggulangi HIV/AIDS, namun jumlah kasus HIV/AIDS meningkat setiap tahun. Tujuan penelitian ini untuk mengetahui efektivitas collaborative governance antarpemangku kepentingan dalam pelayanan komprehensif berkesinambungan untuk menanggulangi HIV/AIDS di Kota Surakarta. Penelitian ini merupakan studi kasus jenis exploratory. Informan ditentukan dengan menggunakan purposive sampling. Pengumpulan data dilakukan pada 2 Juli – 2 September 2013 dengan wawancara mendalam, observasi, focus group discussion, dan dokumentasi. Teknik analisis data dengan model analisis interaktif. Hasil penelitian menunjukkan bahwa pemberi dan penerima layanan berperan dalam penanggulangan HIV/AIDS sesuai tugas dan fungsinya masing-masing. Program pencegahan dan penjangkauan, layanan kesehatan, reduksi bahaya, dan pemberdayaan belum efektif karena komitmen terhadap tujuan dan sikap saling percaya antarpemangku kepentingan belum optimal, petugas lapangan kurang profesional, terdapat konflik laten antarpemangku kepentingan, kurang optimalnya koordinasi antaranggota Komisi Penanggulangan AIDS Daerah Kota Surakarta dan rendahnya anggaran untuk penanggulangan HIV/AIDS karena HIV/AIDS belum menjadi isu prioritas dalam pembangunan daerah. Disimpulkan bahwa kolaborasi governance antarpemangku kepentingan belum efektif. Untuk meningkatkan kualitas dan efektivitas kolaborasi governance antarpemangku kepentingan, harus ada norma, struktur, dan proses yang jelas dalam menanggulangi HIV/AIDS.AbstractThere have been public policies, programs and activities to cope with HIV/AIDS in Indonesia at national and local level, but number of HIV/AIDScases is increasing every year. This study aimed to determine effectivity ofcollaborative governance between stakeholders in a sustainable comprehensive service to cope with HIV/AIDS in Surakarta City. This study was an exploratory study. Informants were selected using purposive sampling technique. Data collection was conducted on 2 July – 2 September 2013 using in-depth interview, observation, focus group discussion, and documentation. Technique of data analysis was an interactive analysis model. Results showed that service provider and receiver had taken roles in HIV/AIDS coping based on their own duty and function. Prevention and outreach, healthcare service, harm reduction and empowerment programs had not been yet effective because of less optimal commitment to purpose and mutual trust between stakeholders, less professional fieldworkers, latent conflict occurred between stakeholders, less optimal coordination between AIDS Coping Commission of Surakarta City members, and low budget for HIV/AIDS coping as HIV/AIDS is not yet a priority issue in regional development. In brief, collaborative governance between stakeholders is not yet efffective. To improve the quality and the collaborative governance effectivity between stakeholders, there should be any clear norm, structure and process in coping with HIV/AIDS.

Solar eclipses draw the attention of the general public to celestial events in the countries from which they are visible, and broad public education programs are necessary to promote safe observations. Most recently, a subcommittee of IAU Commission 46 composed of Julieta Fierro (from the National University of Mexico), the Canadian professor of optometry Ralph Chou (from the University of Waterloo) and me provided information about safe observations of the 24 October 1995 eclipse to people in Pakistan, India, Cambodia, Vietnam, and Guam. An important point is that there are advantages to seeing eclipses, including inspiration to students, and that people must always be given correct information. If scare techniques are used to warn people off eclipses, when it is later found out that the eclipse was not dangerous and, indeed, was spectacular, these students and other individuals will not trust warnings for truly hazardous activities like smoking, drugs, and behavior that puts one at risk for AIDS.

<p><em>A</em><em>c</em><em>quired Immune Deficiency Syndrome (AIDS )isasyndrome inthe formof symptom sand infections thatarise because aperson infect edwiththe Human Immuno deficiency Virus (HIV),Thereport isba sedon the NAC (National AIDS Commission) of West Sumatra, aswell asreportsfromDisease Prevention Section ofWest Sumatra Provincial HealthOffice, Theres earch objective wasto analyze the implementation ofthe HIV and AIDS counte rmeasure program.Thedesig nofthis study use daqualitative approach with the methodo fsystem analysis of the data input, process ,output. Results from the study showed that the absen ceoflocal polici eson the implementation of the HIV and AIDS counterm easure programs, resourc epoweris still lacking and the off icershave double duty, the Departmen to Health does not havea HIV national guide book, also the fund sfrom the goverment budget is not focuse donthe HIV and AIDS, the fund also usedfor P2PL (environmental health and control program), in addition to technical problems, the coordination withvarious programs also has notgone well. It isrecommen ded that local authorities, especially Bukittinggi health department to makes regulations orlaws, which regulate </em><em>t</em><em>echnical implementation of the HIV and AIDS count ermea sure program, eit hermayor policy orregulation,sothat the program can run optimally ,the allocation offund sfrom the goverment budget should befocused specifically for this program</em><em>.</em></p><p><em><br /></em></p><p><em>Acquired Immune Deficiency Syndrome </em>(<em>A</em><em>ID</em><em>S</em>) merupakan sindrom berupa gejala dan infeksi yang disebabkan karena terinfeksi <em>Human Immuno deficiency Virus </em>(<em>HIV</em>) dapat menyerang dan merusak system kekebalan tubuh manusia.Tujuan penelitian menganalisa pelaksanaan program penanggulangan HIV dan AIDS. Desain penelitian ini menggunakan metode pendekatan kualitatif dengan metode analisis system dari Data <em>input ,proses ,outpu .</em>Penelitian ini dilakukan di Dinas Kesehatan Kota.Hasil penelitian menunjuk kan bahwa belum adanya kebijakan lokal yang mengatur tentang pelaksanaan program penanggulangan HIV dan AIDS ,sumberdaya tenaga yang masih kurang dan tugas rangkap ,Dinas Kesehatan tidak memiliki buku pedoman nasional manajemen HIV, dan ada dana dari APBD tidak terfokus untuk program penanggulangan HIV dan AIDS menyatu dengan dana pada bidang P2P, Masalah teknis peran serta dan koordinasi dengan linta sprogram dan lintas sektor belum berjalan dengan baik. Disaran kan agar pihak pemerintah daerah khususnya dinas kesehatan kota Bukittinggi membuat regulasi atau peraturan yang mengatur secara teknis pelaksanaan program penanggulangan HIV dan AIDS ini baik berupa kebijakan atau peraturan walikota sehingga program ini dapat berjalan secara maksimal, alokasi dana dari APBD harus terfokus khusus untuk program ini ,diharapkan juga pemerintah khususnya lebih memperhatikan terutama masalah nutrisi para ODHA yang bertugas sebagai penjangkau kasus dilapangan meningkatkan kerja sama lintas program dan sektor serta menguatkan komitmen demi keberhasilan dari program ini.</p><p><em><br /></em></p>

There is a proliferation of works on the new European External Action Service (EEAS). Most of these approach the EEAS through a rationalist framework, assessing how a new institution can solve long-term questions of EU foreign policy-making to ensure consistency and coherence while reducing transaction costs between actors (both supranational and national) in a multilevel governance structure. This paper takes a different direction. Using 30 interviews with officials from the EEAS, the European Commission, and national ministries of foreign affairs, conducted between 2010 and 2013, it shows how the study of practice aids understanding of the nature of the EEAS. As a new institution, the EEAS lends itself particularly well to practice-based study because new institutions must develop new practices.The first section of the article defines the notion of practice and shows the importance of historicizing the struggles around practices in understanding the creation of the EEAS. The second section demonstrates how agents’ practices shape professional cultures within the EEAS. The third section highlights the relationship between practices and rule-making. Going over the EEAS as a case study, the conclusion focuses on the importance of analysing actors’ practices for understanding the current evolution of diplomacy and international relations in general.

Abstract Background The HIV epidemic reached Chile in the mid 1980s, as response a national AIDS commission was created, AIDS care centers were organized (Fundacion Arriaran [FA] was the first) and free antiretroviral therapy (ART) was later provided with progressive coverage, complexity and availability over the years Objective. Quantify evolution of mortality, retention and abandonment (LTFU) over 25 years according to qualitatively different periods in the national program of access to ART, from no availability to full coverage with current drugs at FA center Methods Retrospective analysis of FA updated database of the 5080 adult patients admitted from 1990 to 2014, who were distributed in 4 groups: A: no ART availability (1990–92); B: mono/dual ART (1993–98); C: early modern ART (HAART) (1999–2007) and D: contemporary HAART (2008–14). Mortality, Retention and LTFU were evaluated at 1, 3, 5 and 10 year intervals from admission and at end of 2015. Mortality was included in period of occurrence; LTFU was permanent absence at center of &gt; 6 months during studied period. Local IRB approved the study Results Main results shown in Table. Mortality varied from 40% to 2%, and 62% to 7% at 1 and 5 years, for groups A and D respectively; 72% to 16% at 10 years for groups A and C, respectively. Retention at 5 years were 28%, 32%, 72% and 77% for groups A, B, C and D respectively. LTFU was 10%, 17%, 12% and 10% at 5 years for same groups, respectively. At 12/2015 6%, 19%, 61% and 84% from groups A, B, C and D, respectively, remained retained in care Conclusion This study showed the marked reduction in mortality and increase in retention of HIV patients concomitant to expanded access to therapy although LTFU remains a problem. Disclosures All authors: No reported disclosures.

ObjectivesThe 1916 Royal Commission on Venereal Diseases was established in response to epidemics of syphilis and gonorrhoea in the UK. In the 100 years since the Venereal Diseases Act (1917), the UK has experienced substantial scientific, economic and demographic changes. We describe historical and recent trends in STIs in the UK.MethodsWe analysed surveillance data derived from STI clinics’ statistical returns from 1917 to 2016.ResultsSince 1918, gonorrhoea and syphilis diagnoses have fluctuated, reflecting social, economic and technological trends. Following spikes after World Wars I and II, rates declined before re-emerging during the 1960s. At that time, syphilis was more common in men, suggestive of transmission within the men who have sex with men (MSM) population. Behaviour change following the emergence of HIV/AIDS in the 1980s is thought to have facilitated a precipitous decline in diagnoses of both STIs in the mid-1980s. Since the early 2000s, gonorrhoea and syphilis have re-emerged as major public health concerns due to increased transmission among MSM and the spread of antimicrobial-resistant gonorrhoea. Chlamydia and genital warts are now the most commonly diagnosed STIs in the UK and have been the focus of public health interventions, including the national human papillomavirus vaccination programme, which has led to substantial declines in genital warts in young people, and the National Chlamydia Screening Programme in England. Since the 1980s, MSM, black ethnic minorities and young people have experienced the highest STI rates.ConclusionAlthough diagnoses have fluctuated over the last century, STIs continue to be an important public health concern, often affecting more marginalised groups in society. Prevention must remain a public health priority and, as we enter a new era of sexual healthcare provision including online services, priority must be placed on maintaining prompt access for those at greatest risk of STIs.

In a White House ceremony on May 16, 1997, President Clinton issued an apology on behalf of the nation for the Tuskegee Syphilis Study, a forty-year research project in which African-American men were deceived and denied treatment in order to document the natural course of syphilis. Reflection on this occasion can give us pause to take pride in the progress made toward more ethical research with humans. The President's apology is perhaps the most public of a number of recent events representing a renewed attention to ethics in research with human participants. Alongside it stand the efforts of treatment activists for people with acquired immune deficiency syndrome (AIDS) and the revelations of the human radiation experiments. In 1995, President Clinton called for the creation of the National Bioethics Advisory Commission, which was charged with a host of projects aimed at investigating the organization and function of the federal system for overseeing human subjects research in the United States, and giving guidance on specific forms of research.

The increasing health threat arising from emerging infectious disease requires an urgent global response. The accelerated development of vaccines, diagnostics and treatments requires facilitated access to and timely transfer of pertinent research reagents between scientists, especially those from low- and middle-income countries (LMICs) which are frequently the worst affected. To meet this global need, we propose to establish a Centre for Emerging Disease Research Reagents (CEDRR) which will support research on those emerging diseases that pose the greatest threat. This initiative will be based on the model of the Centre for AIDS Reagents, a not-for-profit repository based at the National Institute for Biological Standards and Control (NIBSC), UK, which has been providing a sustained HIV research reagent resource to scientists worldwide for 30 years. CEDRR will encourage leading scientists to donate research materials under an established transfer agreement, that will enable onward supply of samples to requesting laboratories in a manner that protects intellectual property. In addition, we will prepare and commission novel research materials including non-infectious subgenomic clones, recombinant proteins, peptides and antibodies. All the reagents will be characterized and provided individually or as all-in-one packages for specific assays along with detailed data sheets and corresponding standard operating procedures. They will be available globally and access will be prioritized with the objective to help build research capacity in LMICs. In order to provide a service that will meet the scientific community need, CEDRR will actively participate in existing networks and consortia on emerging pathogens, provide frequent newsletters and held regular meetings to discuss reagent requirements. By building an infrastructure that will provide quality research reagents to scientists worldwide, CEDRR hopes to speed up the development of much needed vaccines, diagnostics and treatments to fight emerging pathogens.

AbstractIn the chapter dealing with education and health, the report of the influential Commission for Africa prioritises basic health systems, HIV/AIDS, malaria and tuberculosis. In contrast, nutrition is given less than half a page and is reduced to parasite control and micronutrient support. Such neglect of nutrition is hard to understand in the context of increasing hunger and malnutrition across the continent. Sub-Saharan Africa is the only region in the world where the proportion of underweight children has stagnated and the absolute numbers have actually increased in the last decade. It has been pointed out that if current trends continue sub-Saharan Africa will achieve the Millennium Development Goal for child mortality around 2115 – one century after the target date. Quite clearly those concerned with nutrition need to more powerfully advocate the role of nutrition in lifting Africa out of the spiral of poverty. The present paper argues that to achieve this requires an understanding not just of the critical role of nutrition for health and development (both individual and national), but also of how recent global changes are interacting with changes in food production and supply, other determinants of maternal and child health, and the role and capacity of the state to tackle malnutrition in Africa. It concludes by suggesting some responses that nutritionists could now be making.

The adolescent courtship and sexual behavior, and also gender-based violence against children continue to be a national concern because the condition is quite alarming. Surveys conducted by the Komisi Perlindungan Anak Indonesia/KPAI (Indonesian Child Protection Commission) and the Ministry of Health in 2013 mentions Indonesia 62.7% of adolescents have had sex outside of marriage, and 20% of the 94.270 women aged adolescents in Indonesia had become pregnant out of wedlock, and 21% of them had an abortion. This condition has been increasing vulnerability to various kind of health hazards especially related to reproductive and sexual health, including the growing threat of HIV/AIDS. This study aims to find out how dating and sexual behavior of adolescents in Central Java, and how to handle it. Using a survey method of 10,160 adolescents in Central Java in 2012-2016, the study found that in general, (an average of 67.2%) of adolescents declared that they were dating. While the form of expression of affection towards his courtship is done in various ways, including; holding hands (average 83.4%), lip kisses (average 20%), feeling / stimulating (average 6.7%), and even many have had sex outside of marriage (average 3.3%). If not done prevention and control efforts, it will have a long impact on the nation's resilience. This study recommends the importance of character education in the prevention and control of adolescent’s courtship and sexual behavior.

Objective. This study examines the antiretroviral (ARV) market characteristics for drugs procured and prescribed to Mexico’s Social Protection System in Health beneficiaries between 2008 and 2013, and compares them with international data. Materials and methods. Procurement information from the National Center for the Prevention and the Control of HIV/AIDS was analyzed to estimate volumes and prices of key ARV. Annual costs were compared with data from the World Health Organization’s Global Price Reporting Mechanism for similar countries. Finally, regimens reported in the ARV Drug Management, Logistics and Surveillance System database were reviewed to identify prescription trends and model ARV expenditures until 2018. Results. Results show that the first-line ARV market is concentrated among a small number of patented treatments, in which prescription is clinically adequate, but which prices are higher than those paid by similar countries. The current set of legal and structural options available to policy makers to bring prices down is extremely limited. Conclusions. Different negotiation policies were not successful to decrease ARV high prices in the public health market. The closed list approach had a good impact on prescription quality but was ineffective in reducing prices. The Coordinating Commission for Negotiating the Price of Medicines and other Health Supplies also failed to obtain adequate prices. To maximize purchase efficiency, policy makers should focus on finding long-term legal and political safeguards to counter the high prices imposed by pharmaceutical companies.

School museums – which had been founded mostly in the vicinity of educational institutions – used to collect teaching aids. So-called natural history cabinets were the most popular among them, recommended, inter alia, by the Commission of National Education in 1783. The tradition of collecting this type of exhibits was common until the middle of the 20th century. There are two types to be distinguished: school museums and pedagogical museums, which differ with respect to the character of their activity and the kind of exhibits. School museums collected basically objects of natural science, instruments for teaching geography, chemistry and mathematics as well as prints and facilities used during lessons. The second group also specialised in exhibits of natural science, but they were no longer used and usually of higher scientific value, including patterns and examples known in the education system. Among the earliest school museums created in the Kingdom of Poland were Warsaw collections of the Institute for Deaf and Blind People (1875), and those of the Eugeniusz Babiński’s so-called Realschule. At the beginning of the 20th century the idea was spreading, inspired inter alia by the exemplary activity of the Polish School Museum in Lviv (1903). The biggest number of school museums and collections were created in institutions founded by the Polish Educational Society (1906–1907). The survived resources give us relatively detailed information about the collections from Warsaw and Pabianice, which aspired to be categorised as pedagogical museums. The Secondary School for Boys of the Merchants Association in Łódź and the Pedagogical Museum in Warsaw (1917) had also in their possession some interesting collections. The latter one was based upon the collections of former governmental schools, in which – in accordance with a decree issued by Russian authorities – the scientific exhibits were to be collected.

Abstract Abstract 1186 Background: In response to the transfusion-transmitted AIDS epidemic the Commission of Inquiry on the Blood System in Canada recommended the development of a monitoring and tracking system of product usage. The Association of Hemophilia Clinic Directors of Canada (AHCDC) implemented the Canadian Hemophilia Assessment and Resource Management System (CHARMS) to track factor concentrates (FC) from the sole suppliers, Canadian Blood Services (CBS) and Hema-Quebec (HQ), to hospitals and to patients' homes. Objective: To identify the indications and locations for infusions of factor VIII (FVIII), factor IX (FIX), recombinant factor VIIa (rFVIIa) and FVIII inhibitor bypass activity (FEIBA) and review utilization during 2000–2009. Methods: All Canadian patients with hemophilia attend the 26 Canadian Hemophilia Treatment Centres (HTCs) and are registered with the Canadian Hemophilia Registry (CHR; ahcdc.ca) from which they receive a unique number suitable for anonymizing data. HTCs receive product and infusion data from the blood suppliers (CBS, HQ), regional hospitals and patients. HTCs enter these data into their clinic-based CHARMS software program and then export the data to the national database (CentrePoint) where data are validated. Results: From 2000 to 2009, 2,904 patients received, predominantly, FVIII (902 million Units) and FIX (240 million Units). A total of 2,386(82%) had congenital bleeding disorders listed in the Canadian Hemophilia Registry. The remaining 518 were not registered because they either did not have inherited factor deficiency or had registrations pending. Most of FVIII and FIX was infused by patients at home: 90% to 95% for FVIII and 85% to 94% for FIX. The yearly amount of FVIII infused increased over time; this was accounted for by an increase in the number of patients who were treated shown by positive and significant correlation(r=0.89; p=0.04), not so by amount infused per patient which remained constant (p=0.57). Furthermore, there was a linear relationship between an increase in patients and increased utilization, each additional patient predicting for an increased utilization of 96,217 units (P=.04). The highest proportional utilization of both FVIII and FIX was for prophylaxis, and this proportion increased over time, while the proportion used for bleeding remained steady. In 2009, the proportions used for prophylaxis were 73% and 60% for factor VIII and factor IX respectively; for bleeding the proportions were 16% and 30%, for surgery 1% and 4%, for immune tolerance induction 3% and 1%, and unclassified use was 6% and 5% respectively. Among inhibitor by-passing products, rFVIIa was the product most used by patients without bleeding disorders, 20% of VIIa being used by these patients but only 6% of FIEBA. FIEBA was predominant over rFVIIa for prophylaxis in children. Improvements in data collection included a notable decrease in the proportion of Unclassified usage; for FVIII from 12–36% each year from 2000–2004 to 6–16% from 2005–2009; for FIX from 14–41% each year before 2005 to 4–14% after 2004. Specifically, the decrease in Unclassified infusions of FVIII from 16% in 2005 to 6% in 2009 showed a statistically significant trend (p=.02). Conclusions: 1) Data collection became reliable after 2004 when the proportion of Unclassified indications and the annual increase in patient numbers fell to low levels; hence subsequent trends should be compared with the period 2005–2009. 2) The increase in total annual FVIII concentrate use is accounted for by the annual increase in patient numbers, not by the annual use per patient, 3) FC are increasingly being infused for prophylaxis. 4) The major site of infusion is at home, which is outside the scope of the existing tracking system and which comprises only blood suppliers and hospitals; hence, HTCs and a comprehensive data collection system, CHARMS in this case, are both required components of an effective national tracking system and 5) a tracking system involving the entire supply and treatment chain is essential for predicting utilization and planning for future needs. Disclosures: Walker: Baxter Corporation: Research Funding. Iorio:Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; NovoNordisk: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Baxter: Membership on an entity's Board of Directors or advisory committees; Bayer: Research Funding; BioGen Idec: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Heddle:Baxter: Research Funding; Association of Hemophilia Clinic Directors of Canada: Research Funding. Chan:Bayer: Consultancy; Boehringer ingelheim: Member of DMSB for Clinical Trial, Member of DMSB for Clinical Trial Other; Aventis: Chair of Steering Committee, Chair of Steering Committee Other; BMS: Chair of Adjudication Committee Other.

AbstractThis article examines the role of the African Commission on Human and Peoples' Rights (African Commission) in establishing norms and standards on HIV and human rights that will assist African governments in addressing human rights abuses in the context of HIV as well as in combating the spread of the epidemic. The article argues that through the promotional and protective mandate of the Commission, opportunity exists for the establishment of important norms and standards to guide African states in addressing human rights challenges raised by HIV/AIDS. It concludes by arguing that the African Commission needs to forge more collaboration with states and civil society groups to ensure proper implementation of its norms and standards at the national level

ABSTRACT : The high number of HIV AIDS cases in the city of Yogyakarta requires the authorities to take appropriate action so that the spread of this virus can be minimized. KPAD has important duties and positions to provide maximum services for vulnerable community groups infected with the virus. based on the results of research, public service management applied in KPA Kota Yogyakarta is more coordinative and indirect service. They focus on maximizing the role of OPDs, NGOs, and communities in order to reach out to vulnerable communities who are infected with the HIV AIDS virus. This measure is effectively marked by the multitude of coordination activities between institutions so as to identify HIV sufferers from the early stages and provide the right follow-up.Keywords : Public Service, National AIDS Commission, HIV AIDS ABSTRAK : Tingginya kasus HIV AIDS di Kota Yogyakarta menuntut pihak berwenang melakukan tindakan yang tepat agar penyebaran virus ini dapat diminimalisir. KPAD memiliki tugas dan posisi penting guna memberikan pelayanan maksimal bagi kelompok masyarakat rentan terinfeksi virus tersebut. berdasarkan hasil penelitian, manajemen pelayanan publik yang diterapkan di KPA Kota Yogyakarta lebih bersifat koordinatif dan pelayanan tidak langsung. Mereka fokus pada memaksimalkan peran OPD, LSM, dan masyarakat guna menjangkau kelompok masyarakat yang rentan terinfeksi virus HIV AIDS. Langkah ini dinilai efektif ditandai dengan banyaknya kegiatan koordinatif antar lembaga sehingga mampu mengidentifikasi penderita HIV dari tahap awal dan memberikan pelayaan lanjutan yang tepat.Kata Kunci : Pelayanan Publik, Komisi Penanggulangan AIDS, HIV AIDS

Background: Karo District is one of the districts in North Sumatera province where from 2016 to 2018 the number of HIV sufferers increased dramatically to 384 people and then it increased to 775 people up to September 2020. The aim of this study was to explore the experiences of people with HIV/AIDS and the experiences of the church members regarding people living with HIV/AIDS (PLWHA).Design and Methods: Qualitative research design with descriptive phenomenology approach. Data collection was carried out by interviewing 34 participants in Karo District. The data analysis in this study used the Collaizi technique.Results: Five themes were obtained from the results of the study, namely the responses of the participants diagnosed with HIV/AIDS, health problems faced by PLWHA, stigma and discrimination, the support of family and church members given to PWLHA, and family/church members' expectations toward PLWHA.Conclusions: Based on the findings of the themes, the role of the National AIDS Commission of Moderamen Karo Batak Protestant Church (GBKP) in responding to HIV and AIDS cannot be optimally implemented because of some obstacles namely, localization which is a determinant of the spread of cases, the unavailability of service and ARV in all health centers, lack of sectoral cross-cooperation, very insufficient financial support from the government, the role of nurses played only in the hospitals and the stigmatism to those people with HIV/AIDS due to lack of knowledge of HIV and AIDS.

The implementation of compulsory notification of HIV in France has been the subject of debate for many years, mainly due to concern for the human rights of patients with HIV, with only AIDS cases being notified. An anonymous reporting system for HIV infection was scheduled to begin in 1999, but this was delayed due to opposition from organisations demanding measures to strengthen patient anonymity and data protection. The new system is the product of extensive collaboration between the Institut de Veille Sanitaire (InVS), patient associations, civil rights groups, health care professionals (microbiologists, clinicians, epidemiologists), the ministry of health, and expert committees (on safety, ethics), all of whom are represented on a steering committee. The new arrangements, which reinforce patient anonymity and data protection, meets the requirements of the parties involved, and has been authorised by the National Commission for data processing and liberty (CNIL), the national authority for the protection of personal data collected on individuals.

Abstract Objectives The objectives of this bottleneck analysis are to 1) Diagnose bottlenecks at the health facility and health system levels in the provision of care and feeding of the small and sick newborn (SSNB) within the context of the Baby Friendly Hospital Initiative (BFHI) in Malawi, 2) Provide recommendations to address the identified bottlenecks. Methods The Every Newborn Action Plan (ENAP) bottleneck analysis tool was adapted to provide an increased focus on care and feeding of the SSNB. Using the adapted bottleneck analysis tool, we conducted facility-based observations and interviews with clinical and supervisory staff at eight hospitals to assess for bottlenecks at the facility level. To identify health system bottlenecks, interviews were conducted with key district- and national-level Ministry of Health personnel, and a desk review of key national nutrition and child health policies and guidelines was conducted. Information collected from interviews and extracted from national policies and guidelines were collated and analyzed for the presence/absence of significant bottlenecks. Results Significant bottlenecks were similar across the eight hospitals and included: unskilled staff in feeding concerns of the SSNB; overburdened and understaffed hospitals; lack of feeding cups for infants who are unable to suckle; limited space in the maternity ward for mothers and other caregivers to be present and feed their infant; no job aids or supportive supervision protocols or guidelines around care of the SSNB; no national policies in place to ensure monitoring of care of the SSNB. Key actions to address the identified bottlenecks are presented — including task shifting, improving mechanisms for monitoring care of SSNBs, and capacity-building of health providers — with consideration around how they could be implemented through Malawi's existing and scaled Baby-Friendly Hospital Initiative platform. Conclusions This assessment revealed the need to strengthen the provision of care and feeding of the SSNB. Addressing gaps in each of the six ENAP building blocks will be critical for improving newborn nutrition and health outcomes, and Malawi's already existing BFHI platform could provide an ideal platform for addressing the identified bottlenecks. Funding Sources United States Agency for International Development (USAID).

<p>HIV-AIDS epidemic is a global crisis phenomenon and the hardes challenges for social development, particularly for underdevelopment countries. In general, people with HIV-AIDS are adults who are at the productive age and almost half are women. The National HIV-AIDS Prevention Commission stated that the number of housewives infected by HIV continues to increase significantly every year. Conversely, the number<br />of HIV infected people from commercial sex workers decreased. This is due to HIV transmission from their husband or intimate partners who have risky behavior. This condition concern an increase in the number of cases of HIV transmission from mother to child. HIV-AIDS problems are expected immediately handled and focused on the prevention of HIV-AIDS on housewives. An attempt to strengthen human rights program on <br />women’s reproduction and improve women’s bargaining power to resist high risk sexual relations must be implemented sustainably.</p><p>HIV-AIDS merupakan fenomena krisis global dan tantangan yang berat bagi pembangunan dan kemajuan social, terutama bagi negara-negara miskin. Pada umumnya, penderita HIV-AIDS adalah orang dewasa yang berada dalam usia produktif dan hampir separuhnya adalah wanita. Komisi<br />Penanggulangan AIDS Nasional (KPAN) menyatakan bahwa jumlah ibu rumah tangga yang terinfeksi HIV di Indonesia terus meningkat secara signifikan setiap tahunnya, sebaliknya jumlah pekerja seks komersial yang terinfeksi HIV terus menurun. Hal tersebut disebabkan penularan HIV dari suami atau pasangan intim yang memiliki perilaku beresiko. Kondisi ini dikhawatirkan terjadi peningkatan jumlah kasus penularan dari ib ke anak. Permasalahan HIV diharapkan dapat segera ditangani dengan baik dan difokuskan pada pencegahan HIV-AIDS pada ibu rumah tangga. Seharusnya terus dilakukan upaya memperkuat program-program hak asasi reproduksi perempuan dan meningkatkan kekuatan menawar wanita untuk menolak hubungan seksual beresiko tinggi.</p><p><br /><br /></p>

Abstract Background In the absence of vaccine or cure, public knowledge about Human Immune Virus (HIV) is a central tool for curbing HIV epidemic. This study sought to assess the knowledge of HIV among older adults (50 years and above) at the Methodist Faith Healing hospital, Ankaase, Ghana. Methods Using a descriptive study design, older adults (50 years and above) who visited the Ankaase Methodist Faith Healing hospital were randomly sampled for the study. A structured questionnaire was administered to collect data which was analyzed quantitatively using Statistical Package for Social Sciences (SPSS version 16.0). Results A total of 100 respondents who were aged 50 to 68 (54 ± 2.3) were recruited. Most of the respondents had average knowledge of the mode of HIV transmission (62%) as well as HIV prevention (58%) and signs and symptoms of HIV (60%). HIV status was significantly associated with HIV knowledge among older adults as HIV positive respondents were 2.25 times more knowledgeable in terms of signs and symptoms, mode of transmission and prevention of HIV [AOR (95% CI) 2.25(1.02–8.68)]. Conclusion Most older adults (50 years and above) have average knowledge of the mode of transmission, prevention as well as signs and symptoms of HIV. The National Commission for Civic Education should collaborate with various key stakeholders to educate older adults on issues related to HIV/AIDS.

The transmission of HIV from patient to healthcare worker in an occupational setting was first documented in 1984 (1). In countries that have surveillance and HIV testing systems to recognise occupationally acquired cases, over 100 cases of HIV transmission after an occupational exposure were reported worldwide up to June 1999 (2). Antiretroviral drugs are used for post-exposure prophylaxis (PEP), and zidovudine alone is said to reduce transmission of HIV by 81% (3), but failures of PEP have been documented (4). The European Commission has recently funded a project to develop guidelines for the standardised management of occupational exposures to HIV/bloodborne infections and evaluation of PEP in Europe. The EuRoPEP (European Registry of Post-Exposure Prophylaxis) project is coordinated by the Istituto Nazionale per le Malattie Infettive, Lazzaro Spallanzani, Rome, and involves a group of expert representatives from Croatia, Denmark, France, Germany, Italy, Portugal, Spain, Switzerland, and the United Kingdom. The group presented two abstracts at the XIV International AIDS Conference in Barcelona, Spain (7-12 July 2002, http://www.aids2002.com/). The first assessed current policies and practice for the management of occupational exposures and PEP (5); the second aimed to provide a set of recommendations based on a review of national management strategies as discussed during a consensus meeting (6), and copies are available on request: (irapep@inmi.it).

The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has on the request from the Norwegian Food Safety Authority (Mattilsynet) assessed four studies on developmental neurotoxicity following low dose exposure to bisphenol A (BPA) (Adriani et al., 2003; Carr et al., 2003; Negishi et al., 2004; Ryan and Vandenbergh, 2006). The background for the request is uncertainties related to developmental neurotoxcity of BPA raised by the Nordic environmental agencies in Norway, Sweden and Denmark. VKM was asked to consider if these studies provide sufficient evidence to set a lower no observed adverse effect level (NOAEL) in the hazard characterisation of BPA. Further, a Norwegian exposure scenario based on available exposure data should be performed. The task has been assessed by the Scientific Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics (Panel 4). Bisphenol A (CAS number 80-05-7) is primarily used as a monomer in the production of polycarbonate, which is used to make food containers, such as beverage bottles, baby bottles, tableware and storage containers. It is also used as a precursor of certain epoxy resins used for protective coatings for food and beverage cans. BPA is permitted for use in food contact materials in the European Union (EU) with a specific migration limit (SML) of 0.6 mg/kg food. The migration limit in the EU regulations has yet to be modified according to an opinion from the European Food Safety Authority (EFSA) from 2006 where a new established tolerable daily intake (TDI) of 0.05 mg BPA/kg body weight (bw) was derived from a NOAEL of 5 mg/kg bw/day. A European Union Risk Assessment Report (RAR) of BPA produced in accordance with Council Regulation (EEC) 793/93 has recently been updated (April 2008) reviewing a previously requested 2-generation study in mice (Tyl et al., 2007) and new data on human exposure and effects of BPA. A NOAEL of 50 mg/kg bw/day was suggested in this report. The Nordic environmental agencies (Norway, Sweden and Denmark) have participated in the discussions on this updated EU RAR of BPA and they strongly disagreed that this NOAEL also covers developmental neurotoxicity. According to the Nordic environmental agencies, the four above mentioned studies indicate a possible risk for developmental neurotoxicity of BPA at very low exposure levels (0.1-0.25 mg/kg bw/day). The position of the Nordic environmental agencies has been included as a footnote in the revised EU RAR. Recently, in April 2008, the U.S. National Toxicology Program (NTP), Health Canada and Environment Canada have published draft reports on effects of BPA, including developmental effects (neural and behavioural effects) and expressed some concern for neural and behavioural effects in fetuses, infants and children at current human exposures. The European Commission has therefore asked EFSA to further assess possible age dependent toxicokinetics of BPA in animals and humans and their implications for hazard and risk assessment of BPA taken into account the most recent information and data available. The present opinion from VKM Panel 4 is based on an evaluation of the design, conduct (or accomplishment) and the results in the four above mentioned studies. The study design has been evaluated in light of international recommendations given in relevant guidelines dealing with developmental neurotoxicity testing in animals. The recent international developments on BPA in the U.S. and Canada are not addressed in this opinion. The report by Tyl and co-workers was central in the EFSA opinion from 2006 and the updated EU RAR from 2008. The Tyl study is a GLP compliant 2-generation reproductive toxicity evaluation in mice performed according to a modified OECD 416 guideline. However, the study did not include functional tests for developmental neurotoxicity. VKM has reviewed the four above mentioned studies on neurodevelopmental toxicity of BPA as requested by the Norwegian Food Safety Authority. Although the design and reporting of these studies suffer from major and serious shortcomings, the overall findings may raise some concern. It is the opinion of the VKM Panel 4 that the four studies do not provide sufficient evidence for setting a robust lower NOAEL for BPA than the current EFSA NOAEL of 5 mg/kg bw/day. The Panel is aware that the EU Commission recently has requested EFSA to re-evaluate the information available on BPA. In order to eliminate any uncertainty regarding potential developmental effects of BPA at low doses, it is recommended that a GLP compliant study is carried out according to OECD guideline 426. Such a study should utilize a broad concentration range from the very low doses up to those with known maternal effects. A Norwegian exposure scenario based on available data on exposure to BPA from food and beverages and via the environment was performed. In general, exposure levels of BPA in Norway are low. The estimated exposure of infants and children is in the range of 3.5 – 13.2 μg/kg bw/day, whereas the estimated aggregated exposure of adults is 1.5 μg/kg bw/day. As a result of the current use of BPA in food contact materials and other consumer products, infants and children are exposed to higher levels of BPA per kg body weight than the rest of the population.

IntroductionWithin Australia, the approach taken to the ways in which disabled people access television is heavily influenced by legislation and activism from abroad. This is increasingly the case as television moves to online modes of distribution where physical and legislative boundaries are more fluid. While early investigations of the intersections between television and the concept of abroad focused on the impacts of representation and national reputation (Boddy), the introduction of new media technologies saw a shifting focus towards the impact and introduction of new media technologies. Drawing on Chan’s definition of media internationalisation as “the process by which the ownership, structure, production, distribution, or content of a country’s media is influenced by foreign media interests, culture and markets” (Chan 71), this article considers the impacts of legislative and advocacy efforts abroad on Australian television audiences with disabilities accessing subscription Video on Demand (VOD).Subscription (VOD) services have caused a major shift in the way television is used and consumed in Australia. Prior to 2015, there was a small subscription VOD industry operating out of this country. Providers such as Quickflix had limited content and the bulk of VOD services used by Australians related to catch-up television, user-generated videos on YouTube or Vimeo, or accessing Netflix US illegally through virtual private networks (VPNs) and proxy services (Ryall; Lombato and Meese). VOD is distinct in that it is generally streamed over Internet-based online services and is not linear, giving viewers the opportunity to watch the video at any time once the programme is available. Unlike broadcast television, there is no particular government or corporate entity controlling the creation of VOD. These services take advantage of the time-shifted convenience of the medium. In addition, VOD is typically not terrestrial, traversing national boundaries and challenging audience expectations and legislative boundaries. This research is concerned with the subscriber model of VOD in Australia where subscribers pay a fee to gain access to large collections of content.This internationalising of television has also offered the opportunity for people with disabilities that previously excluded them from the practice of television consumption, to participate in this national pastime. On an international level, audio description is becoming more available on VOD than it is on broadcast television, thus allowing disabled people access to television. This article situates the Australian approach to VOD accessibility within a broader international framework to question whether the internationalisation of television has affected the ways in which of content is viewed, both at legislative and public levels. While providers are still governed by national regulations, these regulations are influenced by international legislation. Further, the presence and success of advocacy groups to agitate for change has exacerbated the way accessibility is viewed and defined in Australia. The role of the Accessible Netflix Project, in conjunction with changes in the 21st Century Communications and Video Accessibility Act (CVAA) in the USA, has not only reframed accessibility discourse in the US, but also, as companies such as Netflix move abroad, has potentially stimulated a shift in media accessibility standards in Australia.We focus in particular on the impact of three new services – Netflix Australia, Stan, and Presto Entertainment—which entered the Australian market in 2015. At the time, Australia was described as having entered the “streaming wars” and consumers were predicted to be the beneficiaries (Tucker). Despite international moves to improve the accessibility of VOD for disabled consumers, via legislation and advocacy, none of these providers launched with an accessibility policy in place. Even closed captions, whose provision on Australian broadcast television had been mandated via the broadcasting services act since the early 1990s, were conspicuously absent. The absence of audio description was less surprising. With the exception of a 12-week trial on the Australian Broadcasting Commission (ABC) in 2012 and a follow up trial on iView in 2015, audio description has never been available to Australian people who are vision impaired.The findings and methodology of this article are based on research into disability and streaming television in Australia, conducted in 2015 and 2016. Funded by the Australian Communications and Consumer Action Network (ACCAN), the 12-month project reviewed national and international policy; surveyed 145 people with disability; and conducted interviews with media professionals, policy advisors, accessibility advocates, and disabled Australian VOD consumers.Accessibility Abroad Impacting on Local Accessibility: The Netflix ModelDespite the lack of a clear accessibility policy, Netflix is in front in terms of accessibility, with captions available for most content. Audio description for some content became available in April 2015 shortly after its Australian launch. The introduction of this accessibility feature has been directly attributed to the advocacy efforts of the Accessible Netflix Project, an international online movement operating out of the US and advocating for improved accessibility of VOD in the US and abroad (Ellis & Kent). Similarly, Chris Mikul, author of Access on Demand, was interviewed as part of this research. He told us that Netflix’s provision of captions was due to the impacts of legislation in the USA, namely the CVAA. The CVAA, which we discuss later in the paper, while having no jurisdiction in Australia, has improved the availability of captions by mandating accessibility abroad. As a result, accessible content is imported into the Australian market. When Netflix introduced audio description on its original programming, the VOD provider described the access feature as an option customers could choose, “just like choosing the soundtrack in a different language” (Wright). However, despite successful trials, other VOD providers have not introduced audio description as a way to compete with Netflix, and there is no legislation in place regarding the provision of audio description in Australia. People with disability, including people with vision impairments, do use VOD and continue to have particular unmet access needs. As the Netflix example illustrates, both legislation and recognition of people with a disability as a key audience demographic will result in a more accessible television environment.Impact of International LegislationThe accessibility of VOD in Australia has been impacted upon by international legislation in three key ways: through comparative bench-marks, or industry expectations; via user-led expectations and awareness of differing policies and products; and also through the introduction of international providers onto the Australian VOD market, and the presence of parallel-import VOD services. While international VOD providers such as Netflix and iTunes have officially launched in Australia, Australian consumers, both prior to and after the official availability, often access the parallel USA versions of such services. Lombato and Meese theorise that the delays in content launches between the US and Australia, and the limitations caused by licensing agreements (reducing the content availability) have prompted the continued use of Netflix US and a “kind of transnational shop-front hopping” (126). This is significant for VOD content accessibility as it emphasises the effect of, and disparities in national legislation, whereby the same company provides accessible content only in locations in which it is subject to legal requirements. Our analysis of international policy regarding the accessibility of VOD has found a varied approach—from a complete absence of accessibility regulations (New Zealand), to a layering of policy through disability discrimination acts alongside new media laws (USA). Additionally, this need to address convergence and new media in media accessibility regulation is currently a subject being discussed at government levels in some countries, primarily in the UK (ATVOD). However, outside of the USA, there remains either a lack of accessibility policies for media, new or old—as is the case in Singapore—or a lack of policies that facilitate accessibility for the VOD market—such as in Australia where a level of accessibility is required for broadcasters and subscription television but not VOD.While these changes and advancements in accessibility are taking place abroad, the space that online businesses occupy is fluid. The accessibility requirements of physical spaces cross national boundaries, and operate across multiple media and technologies, and thus, multiple media laws. For example, Australian television broadcasters are subject to some captioning requirements, yet VOD is not. Furthermore, catch-up VOD services provided by mainstream Australian television broadcasters are not subject to these laws. While legislation that accommodates convergence and the new digital media landscape is logical (ACMA) there remain few examples globally that have made changes to reflect accessibility requirements in this context. The CVAA in the US is perhaps the most effective to date, specifically addressing the issue of access to modern communications for people with disability.The CVAA and CaptioningThe CVAA seeks to ensure that “accessibility laws enacted in the 1980s and 1990s are brought up to date with 21st century technologies, including new digital, broadband, and mobile innovations” (FCC). The CVAA is designed to be forward-thinking and evolve with changing technologies (Varley). As such, the Act has been distinctive in its approach to accessibility for Internet protocol delivered video programming, including VOD. While full accessibility requirements, such as the inclusion of audio description are not addressed, the Act is considered to be the most accessible globally in its requirements for captioning of all content—specifically, English and Spanish—across cable, broadcast, satellite, and VOD content. VOD apps, plug-ins and devices are also required to implement the complete captioning capabilities, with specific requirements for personalised presentation, colour, size, and fonts. This requirement is applied to video programming distributors and to video programming owners. Indeed, programmers are expected to provide captioning compliance certificates, and distributors are required to report a failure to do so. Quality standards have also been established, with an emphasis not simply on the presence of captioning, but also on accuracy, synchronicity, completeness, and appropriate placement of captions. Despite an absence of similar legislation locally, the impacts of these foreign interests will penetrate the Australian market.In Australia, the example set by the CVAA has warranted recommendations by the ACMA and Media Access Australia. In a recent interview, Chris Mikul reinforced the position that, in order for the accessibility of VOD to improve in Australia, a similar Act is needed to the one established in the US. According to Mikul, “The CVAA in the US bridges the gap to some extent with captioning, although it doesn’t venture into online audio description. […] We need something like the CVAA here” (Mikul).Beyond the impact of the CVAA on US VOD programming, the Americans with Disabilities Act (ADA) (1990) has been significant in the developing captioning requirements of the CVAA. In 2010, disability advocates seeking more accessible VOD services attempted to prosecute Netflix under the ADA. The National Association for the Deaf (NAD) argued that Netflix discriminated against those with a hearing impairment by not providing closed captions for all content. At this time, the CVAA did not include captioning requirements for VOD providers. Instead, it was argued that online businesses should be considered as a “place” of publication accommodation, and thus subject to the same standards and anti-discrimination laws. Netflix settled out of court in 2012, agreeing to caption 100% of its content by 2014 (Mullin; Wolford). However, a Federal Appeals Court later ruled that Netflix was not a place of public accommodation and therefore did not have to comply with the ruling (Hattem). Notably, during the case Netflix also argued that it should not be required to provide captions, as it was abiding by CVAA requirements at that time.Accessibility Activism and AdvocacyAdvocates for accessibility, such as the NAD, have impacted not only on the legislative framework for VOD in the USA, but also on the international public perception and expectation of accessibility. It is important to note that many of the help forums generated by international VOD providers mix customers from multiple countries, establishing a global space in which requirements, expectations and perceptions are shared. These spaces generate a transnational accessibility, providing an awareness of what provisions are being made in other countries, and where they are not. Orrego-Carmona conducted a study on subtitling for the purpose of language translation and found the globalisation of audio-visual content and international media flows have impacted on the public view of subtitling. Indeed, this finding can be extended to subtitling for people with disability. In the help forums for VOD providers, users identified an awareness of other more accessible media environments (such as whether companies provided closed captions in other countries), the impact of legislation in other countries on accessibility, and how or if international media companies were replicating accessibility standards transnationally. Social media campaigns, instigated in both the UK and the US are significant examples of consumer and public-led activism for accessibility. “LOVEFiLM hates deaf people”, #subtitleit, launched by the Action on Hearing Loss group in the UK, and #withcaptions, were all effective online campaigns launched by individuals and disability activist groups. In early 2014, comedian Mark Thomas, as part of his show 100 Acts of Minor Dissent, placed two large posters at the entrance to the offices of Amazon UK stating "LOVEFiLM hates deaf people." A subsequent petition through change.com attracted 15154 signatures, asking for rental DVDs that were subtitled to be listed, and all streamed content to be subtitled (https://www.change.org/p/lovefilm-amazon-prime-video-amazon-uk-please-list-your-subtitled-rental-dvds-and-subtitle-your-streamed-content). A year later, Amazon increased the subtitling of its content to 40 percent. As of June 2015 the company was working towards 100% subtitling. The petition turned its attention to Sky On Demand, initiated by Jamie Danjoux, a 17-year-old boy with hearing loss (https://www.change.org/p/sky-enable-subtitles-for-ondemand), has attracted 6556 signatures. The social media campaigns #subtitleit and #withcaptions similarly aimed to target both VOD providers and the government, with the aim for both consistent and compulsory captioning across all VOD content. While UK legislation is yet to specifically address VOD captioning, the subject of accessibility and VOD is currently being debated at policy level. It was also successful in gaining commitments from Sky and BT TV to improve subtitles for their VOD and catch-up VOD programming.In the USA, The Accessible Netflix Project and founder Robert Kingett have been significant advocates for the inclusion of audio description on Netflix and other US VOD providers. Further, while the Accessible Netflix Project has a focus on the United States, its prominence and effectiveness has facilitated awareness of the accessibility of VOD transnationally, and the group internally monitors and comments on international examples. This group was integral in persuading Netflix to provide audio descriptions, a move that has impacted on the level of accessibility worldwide.These advocacy efforts abroad have not only included Australian audiences via their invitations to participate in transnational online spaces, but their success also has direct impact on the availability of captions and audio description imported to Australian video on demand consumers. ConclusionThe national borders of television have always been permeable—with content from abroad influencing programming and culture. However, within Australia, borders have been erected around the television culture with long wait times between shows airing abroad and locally. In addition, licencing deals between overseas distributors and pay television have delayed the introduction of VOD until 2015. That year saw the introduction of three VOD providers to the Australian television landscape: Stan, Presto Entertainment, and Netflix Australia. With the introduction of VOD, it is not only international content that has altered television consumption. Overseas providers have established a firm place in the Australia television marketplace. Even before the formal launch of overseas VOD providers, disabled users were accessing content from providers such as Netflix USA via VPNs and tunnelling services, illustrating both the clear demand for VOD content, and demonstrating the multiple ways in which international legislation and provider approaches to accessibility have permeated the Australian television industry.The rapid increase of ways in which we watch television has increased its accessibility. The nature of video on demand—streamed online and nonlinear—means that the content accessed is no longer as restricted by space, time and television. Audiences are able to personalise and modify access, and can use multiple devices, with multiple assistive technologies and aids. This increasingly accessible environment is the result of legislative and advocacy efforts originating in other countries. Efforts to improve captions and introduce audio description, while not originating in Australia, have seen improvements to the availability of accessibility features for disabled Australian television audiences. To return to Chan’s definition of media internationalisation with which we began this article, a concern with television accessibility while not originating in Australia, has taken place due to the influence of “foreign media interests, culture and markets” (Chan 71).However, despite the increased potential for full accessibility, there remains deficits. Captions and audio description, the two main features that support the playback of online video content in an accessible way, are not consistently provided. There are no clear, applicable legislative requirements for VOD accessibility in Australia. This must change. Based on our research, change at government, industry and advocacy levels are required in order for VOD in Australia to become fully accessible. Legislation needs to be introduced that requires a minimum level of accessibility, including audio description accessibility, on broadcast television and VOD. Further, governments should work to ensure that PWD are aware of the accessibility features that are provided across all media. For VOD providers, it should be recognised that a significant portion of the consumer base could be PWD, or their families and friends may wish to share in the activity of VOD. Establishing an understanding of the different accessibility requirements may come from hiring specialised accessibility consultants to make platforms accessible and useable for PWD. For consumers of VOD and advocates of accessibility, participation in advocacy efforts that encourage and demand that VOD providers improve accessibility options have been shown to increase accessibility abroad, and should be applied to the Australian context.ReferencesACMA. Australian Government. Converged Legislative Frameworks: International Approaches. Jul. 2011. 1 Aug. 2016 <http://www.acma.gov.au/theACMA/Library/researchacma/Occasional-papers/coverged-legislative-frameworks-international-approaches>.ATVOD. Provision of Video on Demand Access Services: A Report on the Level of Provision by On Demand. UK: The Authority for Television on Demand, 18 Dec. 2015. 13 May 2016 <http://stakeholders.ofcom.org.uk/binaries/broadcast/on-demand/accesseuropean/AS_survey_report_2015.pdf>.Boddy, William. "U.S. Television Abroad: Market Power and National Introspection." Quarterly Review of Film and Video 15.2 (1994): 45-55.Chan, Joseph Man. "Media Internationalization in China: Processes and Tensions." Journal of Communication 44.3 (1994): 70-88.Ellis, Katie, and Mike Kent. "Accessible Television: The New Frontier in Disability Media Studies Brings Together Industry Innovation, Government Legislation and Online Activism." First Monday 20 (2015). <http://firstmonday.org/ojs/index.php/fm/article/view/6170>.FCC. 21st Century Communications and Video Accessibility Act (CVAA) 2010. USA: Federal Communications Commission. 27 May 2016 <https://www.fcc.gov/consumers/guides/21st-century-communications-and-video-accessibility-act-cvaa>.Hattem, Julian. “Court: Netflix Doesn’t Have to Comply with Disability Law.” The Hill, 3 Apr. 2015. 20 Aug. 2015 <http://thehill.com/policy/technology/237829-court-netflix-doesnt-have-to-comply-with-disability-law>.Lombato, Roman, and James Meese, eds. “Australia: Circumnavigation Goes Mainstream.” Geoblocking and Global Video Culture. Amsterdam: Institute of Network Cultures, 2016.Media Access Australia. “Policy and Expectations: What You Can Expect on Free-to-air Television.” Australia: Media Access Australia, 2013. 27 May 2016 <http://www.mediaaccess.org.au/tv-video/policy-and-expectations>.Mullin, Joe. “Netflix Settles with Deaf-Rights Group, Agrees to Caption All Videos by 2014.” Arstechnica 11 Oct. 2012. 1 Jan. 2014 <http://arstechnica.com/tech-policy/2012/10/netflix-settles-with-deaf-rights-group-agrees-to-caption-all-videos-by-2014/>.Orrego-Carmona, Daniel. “Subtitling, Video Consumption and Viewers.” Translation Spaces 3 (2014): 51-70.Ryall, Jenni. “How Netflix Is Dominating Australia from Abroad.” Mashable Australia 14 Jul. 2014. 14 Sep. 2016 <http://mashable.com/2014/07/14/how-netflix-is-dominating-australia-from-abroad/#kI9Af70FngqW>.Tucker, Harry. “Netflix Leads the Streaming Wars, Followed by Foxtel’s Presto.” News.com.au 24 Jun. 2015. 18 May 2016 <http://www.news.com.au/technology/home-entertainment/tv/netflix-leads- the-streaming-wars-followed-by-foxtels-presto/news story/7adf45dcd7d9486ff47ec5ea5951287f>.Unites States Government. Americans with Disabilities Act of 1990. 27 May 2016 <http://www.ada.gov/pubs/adastatute08.htm>.Varley, Alex. “New Access for a New Century: We Sit Down with Karen Peltz Strauss.” Media Access Australia 28 Aug. 2013. 27 May 2016 <http://www.mediaaccess.org.au/latest_news/australian-policy-and-legislation/new-access-for-a- new-century>.Wolford, Josh. “Netflix Will Caption All Streaming Videos by 2014, per Settlement.” WebProNews, 11 Oct. 2012. 1 Jan. 2014 <http://www.webpronews.com/netflix-will-caption-all-streaming-videos-by-2014-per-settlement-2012-10/>.Wright, Tracey. “Netflix Begins Audio Description for Visually Impaired.” Netflix, 14 Apr. 2015. 5 June 2016 <http://blog.netflix.com/2015/04/netflix-begins-audio-description-for.html>.

IntroductionBritish initiatives to manage both the number of arrivals of asylum seekers and the experiences of those who arrive have burgeoned in recent years. The budget dedicated to asylum seeker management increased from £357 million in 1998-1999 to £1.71 billion in 2004-2005, making the Immigration and Nationality Directorate (IND) the second largest concern of the Home Office behind the Prison Service in 2005 (Back et al). The IND was replaced in April 2007 by the Border and Immigration Agency (BIA), whose expenditure exceeded £2 billion in 2007-2008 (BIA). Perhaps as a consequence the number of asylum seekers applying to the UK has fallen dramatically, illustrating the continuing influence of exclusionary state policies despite the globalisation and transnationalisation of migrant flows (UNHCR; Koser).One of the difficulties with the study of asylum seekers is the persistent risk that, by employing the term ‘asylum seeker’, research conducted into their experiences will contribute towards the exclusion of a marginalised and abject group of people, precisely by employing a term that emphasises the suspended recognition of a community (Nyers). The ‘asylum seeker’ is a figure defined in law in order to facilitate government-level avoidance of humanitarian obligations by emphasising the non-refugeeness of asylum claimants (Tyler). This group is identified as supplicant to the state, positioning the state itself as a legitimate arbiter. It is in this sense that asylum seekers suffer a degree of cruel optimism (Berlant) – wishing to be recognised as a refugee while nevertheless subject to state-defined discourses, whatever the outcome. The term ‘forced migrant’ is little better, conveying a de-humanising and disabling lack of agency (Turton), while the terms ‘undocumented migrant’, ‘irregular migrant’ and ‘illegal migrant’ all imply a failure to conform to respectable, desirable and legitimate forms of migration.Another consequence of these co-opted and politically subjugating forms of language is their production of simple imagined geographies of migration that position the foreigner as strange, unfamiliar and incapable of communication across this divide. Such imaginings precipitate their own responses, most clearly expressed in the blunt, intrusive uses of space and time in migration governance (Lahav and Guiraudon; Cohen; Guild; Gronendijk). Various institutions exist in Britain that function to actually produce the imagined differences between migrants and citizens, from the two huge, airport-like ‘Asylum Screening Units’ in Liverpool and London where asylum seekers can lodge their claims, to the 12 ‘Removal Centres’ within which soon-to-be deported asylum seekers are incarcerated and the 17 ‘Hearing Centres’ at which British judges preside over the precise legal status of asylum applicants.Less attention, however, has been given to the tension between mobility and stillness in asylum contexts. Asylum seeker management is characterised by a complex combination of enforced stillness and enforced mobility of asylum seeking bodies, and resistance can also be understood in these terms. This research draws upon 37 interviews with asylum seekers, asylum activists, and government employees in the UK conducted between 2005 and 2007 (see Gill) and distils three characteristics of stillness. First, an association between stillness and safety is clearly evident, exacerbated by the fear that the state may force asylum seekers to move at any time. Second, stillness of asylum seekers in a physical, literal sense is intimately related to their psychological condition, underscoring the affectual properties of stillness. Third, the desire to be still, and to be safe, precipitates various political strategies that seek to secure stillness, meaning that stillness functions as more than an aspiration, becoming also a key political metric in the struggle between the included and excluded. In these multiple and contradictory ways stillness is a key factor that structures asylum seekers’ experiences of migration. Governing through Mobility The British state utilises both stillness and mobility in the governance of asylum seeking bodies. On the one hand, asylum seekers’ personal freedoms are routinely curtailed both through their incarceration and through the requirements imposed upon them by the state in terms of ‘signing in’ at local police stations, even when they are not incarcerated, throughout the time that they are awaiting a decision on their claim for asylum (Cwerner). This requirement, which consists of attending a police station to confirm the continuing compliance of the asylum seeker, can vary in frequency, from once every month to once every few days.On the other hand, the British state employs a range of strategies of mobility that serve to deprive asylum seeking communities of geographical stillness and, consequently, also often undermines their psychological stability. First, the seizure of asylum seekers and transportation to a Removal Centre can be sudden and traumatic, and incarceration in this manner is becoming increasingly common (Bacon; Home Office). In extreme cases, very little or no warning is given to asylum seekers who are taken into detention, and so-called ‘dawn raids’ have been organised in order to exploit an element of surprise in the introduction of asylum seekers to detention (Burnett). A second source of forced mobility associated with Removal Centres is the transfer of detainees from one Removal Centre to another for a variety of reasons, from the practical constraints imposed by the capacities of various centres, to differences in the conditions of centres themselves, which are used to form a reward and sanction mechanism among the detainee population (Hayter; Granville-Chapman). Intra-detention estate transfers have increased in scope and significance in recent years: in 2004/5, the most recent financial year for which figures are available, the British government spent over £6.5 million simply moving detainees from one secure facility to another within the UK (Hansard, 2005; 2006).Outside incarceration, a third source of spatial disruption of asylum seekers in the UK concerns their relationship with accommodation providers. Housing is provided to asylum seekers as they await a decision on their claim, but this housing is provided on a ‘no-choice’ basis, meaning that asylum seekers who are not prepared to travel to the accommodation that is allocated to them will forfeit their right to accommodation (Schuster). In other words, accommodation is contingent upon asylum seekers’ willingness to be mobile, producing a direct trade-off between the attractions of accommodation and stillness. The rationale for this “dispersal policy”, is to draw asylum seekers away from London, where the majority of asylum seekers chose to reside before 2000. The maintenance of a diverse portfolio of housing across the UK is resource intensive, with the re-negotiation of housing contracts worth over a £1 billion a constant concern (Noble et al). As these contracts are renegotiated, asylum seekers are expected to move in response to the varying affordability of housing around the country. In parallel to the system of deportee movements within the detention estate therefore, a comparable system of movement of asylum seekers around the UK in response to urban and regional housing market conditions also operates. Stillness as SanctuaryIn all three cases, the psychological stress that movement of asylum seekers can cause is significant. Within detention, according to a series of government reports into the conditions of removal centres, one of the recurring difficulties facing incarcerated asylum seekers is incomprehension of their legal status (e.g. HMIP 2002; 2008). This, coupled with very short warning of impending movements, results in widespread anxiety among detained asylum seekers that they may be deported or transferred imminently. Outside detention, the fear of snatch squads of police officers, or alternatively the fear of hate crimes against asylum seekers (Tyler), render movement in the public realm a dangerous practice in the eyes of many marginalised migrants. The degree of uncertainty and the mental and emotional demands of relocation introduced through forced mobility can have a damaging psychological effect upon an already vulnerable population. Expressing his frustration at this particular implication of the movement of detainees, one activist who had provided sanctuary to over 20 asylum seekers in his community outlined some of the consequences of onward movement.The number of times I’ve had to write panic letters saying you know you cannot move this person to the other end of the country because it destabilises them in terms of their mental health and it is abusive. […] Their solicitors are here, they’re in process, in legal process, they’ve got a community, they’ve got friends, they may even have a partner or a child here and they would still move them.The association between governance, mobility and trepidation highlights one characteristic of stillness in the asylum seeking field: in contra-distinction to the risk associated with movement, to be still is very often to be safe. Given the necessity to flee violence in origin countries and the tendency for destination country governments to require constant re-positioning, often backed-up with the threat of force, stillness comes to be viewed as offering a sort of sanctuary. Indeed, the Independent Asylum Commission charity that has conducted a series of reviews of asylum seekers’ treatment in the UK (Hobson et al.), has recently suggested dispensing with the term ‘asylum’ in favour of ‘sanctuary’ precisely because of the positive associations with security and stability that the latter provides. To be in one place for a sustained period allows networks of human trust and reciprocity to develop which can form the basis of supportive community relationships. Another activist who had accompanied many asylum seekers through the legal process spoke passionately about the functions that communities can serve in asylum seekers’ lives.So you actually become substitute family […] I think it’s what helps people in the midst of trauma when the future is uncertain […] to find a community which values them, which accepts them, which listens to them, where they can begin to find a place and touch a creative life again which they may not have had for years: it’s enormously important.There is a danger in romanticising the benefits of community (Joseph). Indeed, much of the racism and xenophobia directed towards asylum seekers has been the result of local community hostilities towards different national and ethnic groups (Boswell). For many asylum seekers, however, the reciprocal relations found in communities are crucially important to their well-being. What is more, the inclusion of asylum seekers into communities is one of the most effective anti-state and anti-deportation strategies available to activists and asylum seekers alike (Tyler), because it arrests the process of anonymising and cordoning asylum seekers as an homogenous group, providing instead a chance for individuals to cast off this label in favour of more ‘humane’ characteristics: families, learning, friendship, love.Strategies for StillnessFor this reason, the pursuit of stillness among asylum seekers is both a human and political response to their situations – stillness becomes a metric in the struggle between abject migrants and the state. Crucial to this political function is the complex relationship between stillness and social visibility: if an asylum seeker can command their own stillness then they can also have greater influence over their public profile, either in order to develop it or to become less conspicuous.Tyler argues that asylum seekers are what she calls a ‘hypervisible’ social group, referring to the high profile association between a fictional, dehumanised asylum seeking figure and a range of defamatory characteristics circulated by the popular printed press. Stillness can be used to strategically reduce this imposed form of hypervisibility, and to raise awareness of real asylum seeker stories and situations. This is achieved by building community coalitions, which require physically and socially settled asylum seeking families and communities. Asylum advocacy groups and local community support networks work together in the UK in order to generate a genuine public profile of asylum seekers by utilising local and national newspapers, staging public demonstrations, delivering speeches, attending rallies and garnering support among local organisations through art exhibitions, performances and debates. Some activist networks specialise explicitly in supporting asylum seekers in these endeavours, and sympathetic networks of journalists, lawyers, doctors and radio producers combine their expertise with varying degrees of success.These sorts of strategies can produce strong loyalties between local communities and the asylum seekers in their midst, precisely because, through their co-presence, asylum seekers cease to be merely asylum seekers, but become active and valued members of communities. One activist who had helped to organise the protection of an asylum seeker in a church described some of the preparations that had been made for the arrival of immigration task forces in her middle class parish.There were all sorts of things we practiced: if they did break through the door what would we do? We set up a telephone tree so that each person would phone two or three people. We had I don’t know how many cars outside. We arranged a safe house, where we would hide her. We practiced getting her out of the room into a car […] We were expecting them to come at any time. We always had people at the back […] guarding, looking at strangers who might be around and [name] was never, ever allowed to be on her own without a whole group of people completely surrounding her so she could feel safe and we would feel safe. Securing stillness here becomes more than simply an operation to secure geographic fixity: it is a symbolic struggle between state and community, crystallising in specific tactics of spatial and temporal arrangement. It reflects the fear of further forced movement, the abiding association between stillness and safety, and the complex relationship between community visibility and an ability to remain still.There are, nevertheless, drawbacks to these tactics that suggest a very different relationship between stillness and visibility. Juries can be alienated by loud tactics of activism, meaning that asylum seekers can damage their chances of a sympathetic legal hearing if they have had too high a profile. Furthermore, many asylum seekers do not have the benefits of such a dedicated community. An alternative way in which stillness becomes political is through its ability to render invisible the abject body. Invisibility is taken to mean the decision to ‘go underground’, miss the appointments at local police stations and attempt to anticipate the movements of immigration removal enforcement teams. Perversely, although this is a strategy for stillness at the national or regional scale, mobile strategies are often employed at finer scales in order to achieve this objective. Asylum seekers sometimes endure extremely precarious and difficult conditions of housing and subsistence moving from house to house regularly or sleeping and living in cars in order to avoid detection by authorities.This strategy is difficult because it involves a high degree of uncertainty, stress and reliance upon the goodwill of others. One police officer outlined the situation facing many ‘invisible’ asylum seekers as one of poverty and desperation:Immigration haven’t got a clue where they are, they just can’t find them because they’re sofa surfing, that’s living in peoples coffee shops … I see them in the coffee shop and they come up and they’re bloody starving! Despite the difficulties associated with this form of invisibility, it is estimated that this strategy is becoming increasingly common in the UK. In 2006 the Red Cross estimated that there were some 36 000 refused and destitute asylum seekers in England, up from 25 000 the previous year, and reported that their organisation was having to provide induction tours of soup kitchens and night shelters in order to alleviate the conditions of many claimants in these situations (Taylor and Muir). Conclusion The case of asylum seekers in the UK illustrates the multiple, contradictory and splintered character of stillness. While some forms of governance impose stillness upon asylum seeking bodies, in the form of incarceration and ‘signing in’ requirements, other forms of governance impose mobility either within detention or outside it. Consequently stillness figures in the responses of asylum seeking communities in various ways. Given the unwelcome within-country movement of asylum seekers, and adding to this the initial fact of their forced migration from their home countries, the condition of stillness becomes desirable, promising to bring with it stability and safety. These promises contrast the psychological disruption that further mobility, and even the threat of further mobility, can bring about. This illustrates the affectual qualities both of movement and of stillness in the asylum-seeking context. Literal stillness is associated with social and emotional stability that complicates the distinction between real and emotional spaces. While this is certainly not the case uniformly – incarceration and inhibited personal liberties have opposite consequences – the promises of stillness in terms of stability and sanctuary are clearly significant because this desirability leads asylum advocates and asylum seekers to execute a range of political strategies that seek to ensure stillness, either through enhanced or reduced forms of social visibility.The association of mobility with freedom that typifies much of the literature surrounding mobility needs closer inspection. At least in some situations, asylum seekers pursue geographical stillness for the political and psychological benefits it can offer, while mobility is both employed as a subjugating strategy by states and is itself actively resisted by those who constitute its targets.ReferencesBack, Les, Bernadette Farrell and Erin Vandermaas. A Humane Service for Global Citizens. London: South London Citizens, 2005.Bacon, Christine. 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