A Qualitative Study of Perceived Risk for HIV Transmission among Police Officers in Dar es Salaam, Tanzania.

Understanding people's views about HIV transmission by investigating a specific population may help to design effective HIV prevention strategies. In addition, knowing the inherent sexual practices of such a population, as well as the risky circumstances that may facilitate HIV transmission, is crucial for the said strategies to become effective. In this article, we report how police officers in Dar es Salaam, Tanzania, perceived the problem of HIV and AIDS in their local context, particularly in relation to unsafe sexual practices. The study was done with the view to recommending ways by which HIV transmission could be minimised within the police force. The study was conducted among members of the police force in Dar es Salaam, Tanzania. Eight focus group discussions (FGDs) were conducted, with a total of 66 participants who were mixed in terms of age, gender, and marital status. Some of these were caregivers to patients with AIDS. Data were analysed using the interpretive description approach. The participants believed that both individual sexual behaviour and work-related circumstances were sources of HIV infection. They also admitted that they were being tempted to engage in risky sexual practices because of the institutional rules that prohibit officers from getting married during their training and for three years after. Nevertheless, as members of the Police Force, they stressed the fact that the risky sexual behaviour that exposes them to HIV is not limited to the force; it is rather a common problem that is faced by the general population. However, they complained, the nature of their job exposes them to road accident victims, subjecting them further to possible infection, especially when they have to handle these road accident casualties without proper protective gear. Individual sexual behaviour and job-related circumstances are worth investigating if proper advice is to be given to the police regarding HIV prevention strategies. In order to improve the lives of these police officers, there is a need to review the existing institutional rules and practices to accommodate individual sexual needs. In addition, improving their working environment may minimize the risk of HIV transmission from handling casualties in emergency situations

Inclusive computing in special needs classrooms: designing for all

With a growing call for an increased emphasis on computing in school curricula, there is a need to make computing accessible to a diversity of learners. One potential approach is to extend the use of physical toolkits, which have been found to encourage collaboration, sustained engagement and effective learning in classrooms in general. However, little is known as to whether and how these benefits can be leveraged in special needs schools, where learners have a spectrum of distinct cognitive and social needs. Here, we investigate how introducing a physical toolkit can support learning about computing concepts for special education needs (SEN) students in their classroom. By tracing how the students’ interactions—both with the physical toolkit and with each other—unfolded over time, we demonstrate how the design of both the form factor and the learning tasks embedded in a physical toolkit contribute to collaboration, comprehension and engagement when learning in mixed SEN classrooms

Socially-marketed rapid diagnostic tests and ACT in the private sector: ten years of experience in Cambodia.

Whilst some populations have recently experienced dramatic declines in malaria, the majority of those most at risk of Plasmodium falciparum malaria still lack access to effective treatment with artemisinin combination therapy (ACT) and others are already facing parasites resistant to artemisinins.In this context, there is a crucial need to improve both access to and targeting of ACT through greater availability of good quality ACT and parasitological diagnosis. This is an issue of increasing urgency notably in the private commercial sector, which, in many countries, plays an important role in the provision of malaria treatment. The Affordable Medicines Facility for malaria (AMFm) is a recent initiative that aims to increase the provision of affordable ACT in public, private and NGO sectors through a manufacturer-level subsidy. However, to date, there is little documented experience in the programmatic implementation of subsidized ACT in the private sector. Cambodia is in the unique position of having more than 10 years of experience not only in implementing subsidized ACT, but also rapid diagnostic tests (RDT) as part of a nationwide social marketing programme. The programme includes behaviour change communication and the training of private providers as well as the sale and distribution of Malarine, the recommended ACT, and Malacheck, the RDT. This paper describes and evaluates this experience by drawing on the results of household and provider surveys conducted since the start of the programme. The available evidence suggests that providers' and consumers' awareness of Malarine increased rapidly, but that of Malacheck much less so. In addition, improvements in ACT and RDT availability and uptake were relatively slow, particularly in more remote areas.The lack of standardization in the survey methods and the gaps in the data highlight the importance of establishing a clear system for monitoring and evaluation for similar initiatives. Despite these limitations, a number of important lessons can still be learnt. These include the importance of a comprehensive communications strategy and of a sustained and reliable supply of products, with attention to the geographical reach of both. Other important challenges relate to the difficulty in incentivising providers and consumers not only to choose the recommended drug, but to precede this with a confirmatory blood test and ensure that providers adhere to the test results and patients to the treatment regime. In Cambodia, this is particularly complicated due to problems inherent to the drug itself and the emergence of artemisinin resistance

2005 survey report on the wellbeing of the professions: policing, nursing and teaching

This report assesses the wellbeing of the professions of policing, nursing and teaching in Western Australia. The findings are derived from surveys of how individuals think about their occupations, their colleagues and employers. The level of wellbeing affects the ease of attracting and retaining staff and the quality of delivered services. We present and discuss summary results of responses to questionnaires sent in 2005 to 5,180 police, 6,000 nurses and 9,000 teachers. Each of the professions is here regarded as a single group. The number of respondents is sufficient to allow many more detailed analyses to be performed and reported at a later date. A separate document will contain fuller details of the technical aspects of the research

The Perceptions on Male Circumcision as a Preventive Measure Against HIV Infection and Considerations in Scaling up of the Services: A Qualitative Study Among Police Officers in Dar es Salaam, Tanzania.

\ud In recent randomized controlled trials, male circumcision has been proven to complement the available biomedical interventions in decreasing HIV transmission from infected women to uninfected men. Consequently, Tanzania is striving to scale-up safe medical male circumcision to reduce HIV transmission. However, there is a need to investigate the perceptions of male circumcision in Tanzania using specific populations. The purpose of the present study was to assess the perceptions of male circumcision in a cohort of police officers that also served as a source of volunteers for a phase I/II HIV vaccine (HIVIS-03) trial in Dar es Salaam, Tanzania. In-depth interviews with 24 men and 10 women were conducted. Content analysis informed by the socio-ecological model was used to analyze the data. Informants perceived male circumcision as a health-promoting practice that may prevent HIV transmission and other sexually transmitted infections. They reported male circumcision promotes sexual pleasure, confidence and hygiene or sexual cleanliness. They added that it is a religious ritual and a cultural practice that enhances the recognition of manhood in the community. However, informants were concerned about the cost involved in male circumcision and cleanliness of instruments used in medical and traditional male circumcision. They also expressed confusion about the shame of undergoing circumcision at an advanced age and pain that could emanate after circumcision. The participants advocated for health policies that promote medical male circumcision at childhood, specifically along with the vaccination program. The perceived benefit of male circumcision as a preventive strategy to HIV and other sexually transmitted infections is important. However, there is a need to ensure that male circumcision is conducted under hygienic conditions. Integrating male circumcision service in the routine childhood vaccination program may increase its coverage at early childhood. The findings from this investigation provide contextual understanding that may assist in scaling-up male circumcision in Tanzania.\u

The assessment of pain in older people: UK National Guidelines

We are facing a huge increase in the older population over the next 30 years. This brings an anticipated increase in the prevalence of chronic pain and with this comes the challenge of assessment of pain in many varied settings. Our first iteration of this document was published in 2007. But there has been a proliferation of literature and research since then, so we have developed a new set of guidelines. Different patterns and sites of pain were seen in men and women. Age differences suggest that pain prevalence increased with age up to 85 years and then decreased. The available studies on barriers and attitudes to pain management point towards an adherence to bio-medically orientated beliefs about pain, concern amongst clinicians in relation to activity recommendations, and a negative orientation in general towards patients with chronic painful conditions. A multidisciplinary approach to the assessment and treatment of pain is essential, but the assessment is a complex process which is hampered by many communication issues, including cognitive ability and socio-cultural factors. Such issues are part of the UK ageing population. Structured pain education should be implemented that provides all health professionals (whether professionally or non-professionally trained) with standardised education and training in the assessment and management of pain according to level of experience. Although subjective, patient self-report is the most valid and reliable indicator of pain and it may be necessary to ask questions about pain in different ways in order to elicit a response. A number of valid and reliable self-report measures are available and can be used even when moderate dementia exists. The Numerical Rating Scale or verbal descriptors can be used with people who have mild to moderate cognitive impairment. For people with severe cognitive impairment Pain in Advanced Dementia (PAINAD) and Doloplus-2 are recommended. PAINAD and Doloplus-2 scales continue to show positive results in terms of reliability and validity. There has been no recent evaluation of the Abbey pain scale although it is widely used throughout the UK. There is a need for more research into pain assessment using the collaborative role of the multidisciplinary team in all care settings. Self-report questionnaires of function are limited in their ability to capture the fluctuations in capacity and ability. The concentration on items of relevance to the population of interest means that issues of personal relevance can be obscured. Strong associations were seen between pain and depressed mood with each being a risk factor for the other. Additionally, loneliness and social isolation were associated with an increased risk of pain. Clinicians should be cognisant that social isolation and or depressive signs and symptoms may be indicators of pre-existing pain or a predictor of future pain onset. There are a number of evidence based guidelines on pain assessment in older people with or without cognitive impairment from around the world, including Australia and Europe

LGBTQ+ Homelessness policy briefing

LGBTQ+ homelessness is widespread. Nearly half of LGBTQ+ adults surveyed for this study have experienced homelessness over their lifetime, including a fifth within the last year. Risk of homelessness was high among LGBTQ+ adults. Yet confidence in public homelessness services is low. Stakeholders highlighted the importance of inclusive services and trust when addressing specific needs of LGBTQ+ subgroups. Concerns were raised about the strength of commitment to LGBTQ+ equality in current service provision. Recommendations include developing evidence-based ‘good practice’ guidance for services, including a quality mark to assure LGBTQ+ individuals of safe, inclusive support, local authorities proactively and visibly addressing LGBTQ+ homelessness, ensuring targeted and inclusive services to meet the specific needs of marginalised LGBTQ+ people. Specialist services, especially for young LGBTQ+ people, were also identified as important

Blog: Is queer theory relevant to LGBTQ+ homelessness?

Housing is a field known for its ‘wicked problems’. Wicked problems are those that are difficult to solve. They are often very poorly defined, and it is usually hard to work out whose responsibility it is to deal with them. They make us uncomfortable. But they are also really important, because they allow us to see more clearly the systems in which we operate. They force us to examine the assumptions we are making. Who thinks this is a problem? Why do they think it is a problem? How are they defining the problem? What happens as a result of their approach? We can think about this in terms of advantages and disadvantages. Does it help anyone see this as a problem? How

Blog: Pragmatism and queer theory – two opposing forces?

In our last blog, we explored the high levels of homelessness among LGBTQ+ people as – a problem that cannot be easily or neatly solved, that unsettles and discomforts us, and which works to force us to reconceptualise some of our key assumptions. In this blog, we will look more specifically at how we might do this, using and adapting the work of José Muñoz, a Cuban American critical theorist whose approach straddles utopianism and concrete pragmatism