Gender inequality increases women's risk of hiv infection in Moshi, Tanzania

This study examined the hypothesis that multiple dimensions of gender inequality increase women's risk for HIV infection using a population-based survey of 1418 women aged 20 to 44 in Moshi, Tanzania. Three forms of HIV exposures were assessed reflecting gender power imbalance: economic exposures (age difference between partners and partner's contributions to children's expenses), physical exposures (coerced first sex and intimate partner violence) and social exposures (ever had problems conceiving). Behavioural risk factors included number of sexual partners for women in the last three years, partner had other wives or girlfriends, non-use of condom and alcohol use at least once a week in the last 12 months. Multivariate logistic regression analysis showed that a woman had a significantly elevated risk for HIV if she had a partner more than 10 years older (OR=2.5), her partner made low financial contributions to children's expenses (OR=1.7), or she experienced coerced first sex before age 18 years (OR=2.0) even after taking into account the effects of risk behaviour factors. The association between ever had problem conceiving and HIV infection was explained away by risk behaviour factors. The findings lend support to the hypothesis that economic deprivation and experience of sexual violence increase women's vulnerability to HIV, providing further evidence for extending the behavioural approach to HIV interventions to incorporate women's economic empowerment, elimination of gender-based violence and promotion of changing attitudes and behaviours among men.     

Women's lives and sex: Implications for AIDS prevention

Preliminary findings from the Women and AIDS program, a research grants program of the International Center for Research on Women in Washington, D.C. that supports 17 studies in developing countries worldwide, provide a glimpse into the complex interaction between women's social and economic status and risk of HIV infection. In many settings, the cultural norms that demand sexual fidelity and docile and acquiescent sexual behavior among women permit — and sometimes even encourage —early sexual experimentation, multiple partnerships, and aggressive and dominating sexual behavior among men. Drawing upon the findings from the program, the paper analyzes how such cultural norms, together with women's social and economic dependency, can limit a woman's ability to negotiate safer sex with her partner; restrict her access to information and knowledge about her body; force her to sometimes barter sex for survival; increase her vulnerability to physical violence in sexual interaction; and compromise her self-esteem. The findings highlight the limitations of the current HIV/AIDS prevention strategy for reducing women's risk of HIV, and underline the urgency for an approach to prevention that is grounded in the realities of women's lives and sexual experiences — an approach that recognizes the relationship between the dynamics of gender relations, sexual behavior, and HIV risk.     

Poverty,Food Insufficiency and HIV Infection and Sexual Behaviour among Young Rural Zimbabwean Women

Background

Despite a recent decline, Zimbabwe still has the fifth highest adult HIV prevalence in the world at 14.7%; 56% of the population are currently living in extreme poverty.

Design

Cross-sectional population-based survey of 18–22 year olds, conducted in 30 communities in south-eastern Zimbabwe in 2007.

Objective

To examine whether the risk of HIV infection among young rural Zimbabwean women is associated with socio-economic position and whether different socio-economic domains, including food sufficiency, might be associated with HIV risk in different ways.

Methods

Eligible participants completed a structured questionnaire and provided a finger-prick blood sample tested for antibodies to HIV and HSV-2. The relationship between poverty and HIV was explored for three socio-economic domains: ability to afford essential items; asset wealth; food sufficiency. Analyses were performed to examine whether these domains were associated with HIV infection or risk factors for infection among young women, and to explore which factors might mediate the relationship between poverty and HIV.

Results

2593 eligible females participated in the survey and were included in the analyses. Overall HIV prevalence among these young females was 7.7% (95% CI: 6.7–8.7); HSV-2 prevalence was 11.2% (95% CI: 9.9–12.4). Lower socio-economic position was associated with lower educational attainment, earlier marriage, increased risk of depression and anxiety disorders and increased reporting of higher risk sexual behaviours such as earlier sexual debut, more and older sexual partners and transactional sex. Young women reporting insufficient food were at increased risk of HIV infection and HSV-2.

Conclusions

This study provides evidence from Zimbabwe that among young poor women, economic need and food insufficiency are associated with the adoption of unsafe behaviours. Targeted structural interventions that aim to tackle social and economic constraints including insufficient food should be developed and evaluated alongside behaviour and biomedical interventions, as a component of HIV prevention programming and policy.     

Socioeconomic status as a risk factor for HIV infection in women in East, Central and Southern Africa: a systematic review

This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women's access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female's SES and fourteen also included a measurement of partner's SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner's SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES.     

"That Pregnancy Can Bring Noise into the Family": Exploring Intimate Partner Sexual Violence during Pregnancy in the Context of HIV in Zimbabwe

Background

Globally, studies report a high prevalence of intimate partner sexual violence (IPSV) and an association with HIV infection. Despite the criminalisation of IPSV and deliberate sexual HIV infection in Zimbabwe, IPSV remains common. This study explored women''s and health workers'' perspectives and experiences of sexuality and sexual violence in pregnancy, including in relation to HIV testing.

Methods

This qualitative study was part of a larger study of the dynamics of intimate partner violence and HIV in pregnancy in Zimbabwe. Key informant interviews were conducted with health workers and focus group discussions were held with 64 pregnant or nursing mothers attending antenatal and postnatal care clinics in low-income neighbourhoods of Harare, covering the major thematic areas of validated sexual violence research instruments. Thematic content analysis of audio-recorded and transcribed data was conducted.

Results

While women reported some positive experiences of sex in pregnancy, most participants commonly experienced coercive sexual practices. They reported that men failed to understand, or refused to accept, pregnancy and its associated emotional changes, and often forced painful and degrading sexual acts on them, usually while the men were under the influence of alcohol or illicit drugs. Men often refused or delayed HIV testing, and participants reported accounts of HIV-positive men not disclosing their status to their partners and deliberately infecting or attempting to infect them. Women''s passive acceptance of sexual violence was influenced by advice they received from other females to subordinate to their partners and to not deprive men of their conjugal sexual rights.

Conclusions

Cultural and societal factors, unequal gender norms and practices, women''s economic vulnerability, and men''s failure to understand pregnancy and emotional changes, influence men to perpetrate IPSV, leading to high risk of HIV infection.     

Sex Workers Perspectives on Strategies to Reduce Sexual Exploitation and HIV Risk: A Qualitative Study in Tijuana,Mexico

Globally, female sex workers are a population at greatly elevated risk of HIV infection, and the reasons for and context of sex industry involvement have key implications for HIV risk and prevention. Evidence suggests that experiences of sexual exploitation (i.e., forced/coerced sex exchange) contribute to health-related harms. However, public health interventions that address HIV vulnerability and sexual exploitation are lacking. Therefore, the objective of this study was to elicit recommendations for interventions to prevent sexual exploitation and reduce HIV risk from current female sex workers with a history of sexual exploitation or youth sex work. From 2010–2011, we conducted in-depth interviews with sex workers (n = 31) in Tijuana, Mexico who reported having previously experienced sexual exploitation or youth sex work. Participants recommended that interventions aim to (1) reduce susceptibility to sexual exploitation by providing social support and peer-based education; (2) mitigate harms by improving access to HIV prevention resources and psychological support, and reducing gender-based violence; and (3) provide opportunities to exit the sex industry via vocational supports and improved access to effective drug treatment. Structural interventions incorporating these strategies are recommended to reduce susceptibility to sexual exploitation and enhance capacities to prevent HIV infection among marginalized women and girls in Mexico and across international settings.     

Self-reported confidence, attitudes and skills in practical procedures among medical students: questionnaire study

The aim of our study was to investigate the influence of gender, loss of academic year(s), confidence and attitudes of students on the clinical experience gained by undergraduate education. The survey was conducted during 2004 and 2005 in a sample of 182 students of the 5th and the 6th year at J.J. Strossmayer University School of Medicine in Osijek. The participants were grouped and matched according to their gender, regular studying, the number of time(s) student has performed certain practical medical procedure and the self-confidence arisen by performing one. Furthermore, participants were grouped and compared due to their own assessment of their own practical and theoretical medical knowledge, courses which provide them the least and oppositely--the most practical medical knowledge and their attitude toward current medical faculty curriculum on clinical courses as well as the possibilities of improving them. Fisher's exact test and chi2-test were used to estimate statistical differences between the groups and the parameters in research, while coefficient of contingency was introduced with the aim of defining their correlation. The results showed statistically significant differences between male students who performed more practical medical procedures than female (p < 0.001), non-repeaters performed medical procedures more often than repeaters (p < 0.001, C = 0.658) while repeaters thought higher of their theoretical knowledge than non-repeaters (p < 0.005). Data analysis showed statistically significant correlation between clinical experience and the level of confidence (C = 0.944). This study confirmed influence of male gender, regular studying, better opinion about one's own practical skills and higher confidence in one's own work on greater number of clinical skills performed during undergraduate education.     

A Census Tract–Level Examination of Social Determinants of Health among Black/African American Men with Diagnosed HIV Infection, 2005–2009—17 US Areas

Background

HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men (collectively referred to as MSM). A better understanding of the social conditions in which black men live and work may better explain why HIV incidence and diagnosis rates are higher than expected in this population.

Methods

Using data from the National HIV Surveillance System and the US Census Bureau''s American Community Survey, we examined the relationships of HIV diagnosis rates and 5 census tract–level social determinants of health variables for 21,948 black MSM and non-MSM aged ≥15 years residing in 17 areas in the United States. We examined federal poverty status, marital status, education level, employment status, and vacancy status and computed rate ratios (RRs) and prevalence odds ratios (PORs), using logistic regression with zero-inflated negative binomial modeling.

Results

Among black MSM, HIV diagnosis rates decreased as poverty increased (RR: 0.54). At the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts with a higher proportion below the poverty level (POR: 0.81) and with a higher proportion of vacant houses (POR: 0.86). In comparison, housing vacancy was positively associated with HIV diagnosis rates among black non-MSM (RR: 1.65). HIV diagnosis rates were higher for black MSM (RR: 2.75) and non-MSM (RR: 4.90) whose educational level was low. Rates were significantly lower for black MSM (RR: 0.06) and non-MSM (RR: 0.26) as the proportion unemployed and the proportion married increased.

Conclusions

This exploratory study found differences in the patterns of HIV diagnosis rates for black MSM and non-MSM and provides insight into the transmission of HIV infection in areas that reflect substantial disadvantage in education, housing, employment, and income.     

Epidemiological features of HIV infection among pregnant women in Makurdi, Benue State, Nigeria

Women in Benue State have for years had the highest HIV rate in the country, but because the sentinel surveys are anonymized and unlinked, not much is known about the socio-demographic, behavioural and other risk factors that predispose these women to the disease. The HIV/AIDS epidemic in Nigeria does not appear to be a single epidemic but rather multiple epidemics of varying magnitude and trends. This cross-sectional study was therefore carried out to identify the risk factors for HIV/AIDS among these women. A total of 404 consecutive consenting mothers enrolled at the booking clinic were followed up until delivery of their babies. They were interviewed using a semi-structured questionnaire and tested for HIV infection using an ELISA-based kit after obtaining informed consent. Mean age of the mothers was 26+/-6.1 years, 94.8% were married while 50.5% had at least secondary level education. Sixty-one (15.1%) mothers were HIV positive with mothers aged 15-24 years being responsible for 50.8% of all infection. Following bivariate analysis, being single, having a partner with low level of formal education, living in a rural location, being in a polygamous/multiple partner union, being a higher order polygamous wife, being married more than once and reporting a history of a sexually transmitted infection were significantly associated with HIV infection. Monogamous women who lived apart from their partners and women who had ever had blood transfusion were also more likely to be HIV positive. Following multivariate logistic regression, a young age of 15-24 years (multivariate OR=3.3, 95 % CI=1.2-8.4, p=0.02); ever had other STIs (OR=1.6, 95% CI 1.1-2.3, p=0.009); no formal maternal education (OR=0.6, 95% CI 0.4-0.9, p=0.021) and having one lifetime sexual partner (OR=0.4, 95% CI 0.3-0.5, p<0.00001) were significantly associated with HIV infection in the study population. Appropriate interventions must be directed at young people and should include STI control and abstinence education. Blood safety must be ensured as well as a general improvement in the level of formal and health education in this community.     

Mobility,Violence and the Gendering of HIV in Papua New Guinea

The links between gender, sexuality and violence hold serious implications for HIV transmission and its social and economic effects. In Papua New Guinea, enduring and pervasive patterns of male sexual behaviour involving coercion, violence and gang rape are highly conducive to the transmission of HIV and other sexually transmitted infections and have a critical bearing on women's sexual autonomy and health. The realities of violence are intensified by the widespread view that women are responsible for the spread of the virus. This paper engages the theme of mobility to consider the fluid and dynamic character of gender relations and sexuality in contemporary Papua New Guinea, and to gain perspective on constructions of modern masculinity and the discursive representations of gender violence in the context of the escalating HIV epidemic.     

Indices to Measure Risk of HIV Acquisition in Rakai,Uganda

Introduction

Targeting most-at-risk individuals with HIV preventive interventions is cost-effective. We developed gender-specific indices to measure risk of HIV among sexually active individuals in Rakai, Uganda.

Methods

We used multivariable Cox proportional hazards models to estimate time-to-HIV infection associated with candidate predictors. Reduced models were determined using backward selection procedures with Akaike''s information criterion (AIC) as the stopping rule. Model discrimination was determined using Harrell''s concordance index (c index). Model calibration was determined graphically. Nomograms were used to present the final prediction models.

Results

We used samples of 7,497 women and 5,783 men. 342 new infections occurred among females (incidence 1.11/100 person years,) and 225 among the males (incidence 1.00/100 person years). The final model for men included age, education, circumcision status, number of sexual partners, genital ulcer disease symptoms, alcohol use before sex, partner in high risk employment, community type, being unaware of a partner''s HIV status and community HIV prevalence. The Model''s optimism-corrected c index was 69.1 percent (95% CI = 0.66, 0.73). The final women''s model included age, marital status, education, number of sex partners, new sex partner, alcohol consumption by self or partner before sex, concurrent sexual partners, being employed in a high-risk occupation, having genital ulcer disease symptoms, community HIV prevalence, and perceiving oneself or partner to be exposed to HIV. The models optimism-corrected c index was 0.67 (95% CI = 0.64, 0.70). Both models were well calibrated.

Conclusion

These indices were discriminative and well calibrated. This provides proof-of-concept that population-based HIV risk indices can be developed. Further research to validate these indices for other populations is needed.     

中国贫困地区生态环境脆弱性与经济贫困的耦合关系——基于连片特困区714个贫困县的实证分析

保持生态环境与经济建设的协调发展是新阶段国家扶贫开发的重要策略之一.本文以扶贫开发“新纲要”中规划的14个连片特困区714个贫困县为例,基于敏感性-恢复力-压力度(SRP)的概念模型,构建生态脆弱性评价指标体系,从社会、经济两方面构建了县级尺度上的经济贫困评价指标体系,在此基础上,设计了连片特困区生态环境脆弱与经济贫困耦合模型,对研究区生态脆弱性与经济贫困进行了耦合协调度分析.结果表明: “胡焕庸线”能够很好地刻画连片特困区生态环境脆弱性、经济贫困以及两者耦合协调度的空间分布特征,在扶贫开发过程中,应充分考虑“胡焕庸线”对于我国贫困东西格局划分和减贫的影响;连片特困区脆弱生态环境与经济贫困共生共存,应该充分考虑贫困地区生态环境保护的战略意义,通过保护地区生态环境来达到减少经济贫困的目的;研究区一半左右的县市为衰退失调型,且两者不能做到同步发展.     

Gender differences in the diagnosis and treatment of HIV

Many cases of HIV infection in women in the United States are diagnosed very late in the course of their illness. HIV testing should be routinely recommended if a woman presents with certain gynecologic conditions or sexually transmitted diseases. Lack of awareness of HIV status leads to the majority of new sexually transmitted HIV infections. In the United States, most AIDS cases diagnosed among females in 2004 were attributable to high-risk heterosexual contact, disproportionately affecting black and Hispanic women. Depending on the racial/ethnic community being served, obstacles to access to care, including poverty, transportation issues, and cultural and language barriers, must be overcome. The full implications of gender differences in viral load and CD4 count in the treatment of women with HIV are not yet known. Clinical trial data on HIV therapies in women are limited, and most studies that have included women have not been powered to detect gender differences in virologic and immunologic success rates. Timing and choice of treatment are affected by the pharmacokinetics of antiretroviral drugs and the long-term complications of treatment, both of which may be different for men and women with HIV infection.     

Widow inheritance and HIV prevalence in Bondo District, Kenya: baseline results from a prospective cohort study

Background

Widow Inheritance is a widespread cultural practice in sub-Saharan Africa that has been postulated as contributing to risk of HIV transmission. We present baseline results from a study designed to investigate the association between widow inheritance and HIV acquisition.

Methods and Findings

We performed a cross-sectional analysis of baseline data from a prospective cohort study to investigate if widow inheritance is a risk practice for HIV infection. Study participants were 1,987 widows who were interviewed regarding their inheritance status and sexual behavior profile and tested for HIV. Of these widows, 56.3% were inherited. HIV prevalence, at 63%, was similar among non-inherited and inherited widows. We stratified exposure status by the relationship of the widow to the inheritor and the reason for inheritance, and reexamined the HIV status of four subgroups of inherited women relative to the HIV status of non-inherited women. When adjusting for age and level of formal education, widows who were inherited by non-relatives for sexual ritual were significantly more likely to be infected than widows who were not inherited (OR = 2.07; 95%CI 1.49–2.86); widows who were inherited by relatives for sexual ritual also had elevated odds of HIV infection (OR = 1.34; 95%CI = 1.07–1.70). Widows who were inherited by relatives for companionship were less likely than women who were not inherited to be infected with HIV (OR = 0.85; 95%CI 0.63–1.14).

Conclusions

HIV prevalence among inherited widows varied depending upon why and by whom they were inherited. The cohort study will determine the risk for HIV acquisition among the HIV seronegative widows in this sample.     

秦巴特困区生态脆弱性与经济贫困的耦合关系——以陕西省山阳县为例

以国家扶贫开发重点县山阳县为例,采用遥感与地理信息技术对研究区的生态脆弱性进行定量评价,并构建以行政村为单元的经济贫困评价指标体系,以此分析研究区生态脆弱性与经济贫困耦合协调度的空间分异特征。研究结果表明:①山阳县生态脆弱性整体处于中等偏高水平,生态脆弱性高的地区集中分布在人类活动频繁的河川地带和水土流失严重的低山区;②贫困程度整体较深,地形条件、资源丰度、交通通达性及经济区位的综合差异形成了山阳县经济贫困的空间分布格局;③将山阳县生态脆弱性与经济贫困的耦合关系分为失调共损型、失调环境滞后型、失调经济滞后型、协调同步型、协调环境滞后型及协调经济滞后型六种类型,协调同步型行政村比例仅为13.0%,生态脆弱性与经济贫困的耦合协调度整体较低;④失调共损型、协调同步型及协调环境滞后型空间分布较分散,失调环境滞后型、失调经济滞后型及协调经济滞后型有明显的集聚区,失调环境滞后型和协调经济滞后型集中分布在低山河谷区,失调经济滞后型集中分布在海拔1000 m以上的偏远山区。     

生态脆弱区农户返贫脆弱性评估及其影响因素——以陇南山区为例

生态脆弱区既是生态环境最敏感区域,也是返贫问题较为集中的区域,返贫脆弱性作为评价农户返贫状况的重要指标,可为生态脆弱区农户的防返贫提供有效借鉴。以地处西秦岭的陇南山区为例,构建农户的返贫脆弱性评价指标体系,并利用微观调查数据,测度农户的返贫脆弱性水平,并利用分位数回归模型揭示其影响因素。结果发现:(1)陇南山区农户返贫脆弱性指数均值为0.103,整体处于中度脆弱水平,等级分布呈"两头小中间大"的橄榄形态势。(2)不同类型农户的返贫脆弱性水平存在分化特征,高山区、农业收入占比高、抚养比高的农户返贫脆弱性较高,且农业收入占比高、抚养比高农户的高脆弱群体占比也高。(3)不同抚养比农户的暴露度与适应能力差异最为显著,敏感性水平则在不同生计方式和抚养比农户中差异最大。(4)家庭规模的扩大可显著增强农户的返贫脆弱性,而交通便利度、网络覆盖率、未来生活预期、帮扶措施多样化和政策帮扶强度的提高可有效减缓农户的返贫脆弱性;政策帮扶强度削弱了高度脆弱农户因交通便利度低所致的返贫脆弱性,帮扶措施多样化则减弱了户主受教育水平高所发挥的降脆效果。     

Chromosomal defects in 34 male homosexuals,half of them with HIV antibodies

Most of the research about viral interactions with human chromosomes was done during the sixties and early seventies and very few was performed after the human immunodeficiency virus (HIV) appearance as an epidemic in the eighties. The objective of this work was to estimate if particular chromosomal changes follow the infection of homosexual males by HIV and to determine if the lifestyle, habits, sexual practices, of our sample of male homosexuals predisposes them to chromosomal abnormalities at a higher rate than the background level of cytogenetic damage the general population has. This was a double blinded case-control study, 17 individuals positive for HIV antibodies (HIV+) detected by enzyme-linked immunosorbent assay (ELISA) and confirmed by western blot (WB) were the cases, and 17 individuals negative for HIV antibodies (HIV-) the controls. These men were a very homogeneous population in terms of age, social status, lifestyles, drug abuse, sexual practices and education. Blood was collected between September 1988 and October 1989. Fresh whole blood was cultured in duplicate for 72 hr. Cell harvest followed conventional methods. Once all cell cultures were gathered, the tubes were picked up at random and air dried chromosome preparations were trypsin-giemsa banded (GTG) after overnight incubation at 60 C degrees. The percentage of gaps and breaks these men had was not different from the reported for the general population, nor were there significant difference among both groups (O.R. = 1.8) in items of amount of chromosomal fragility. The distinction among them was at the level of the specific chromosomal sites where the gaps and breaks located, being sites at 2p21 and at 3p21 four times more frequent among HIV+. These probably represent viral modification sites on chromosomes which are known to look like non-staining gaps which are caused by the virus or viral products. This presumption is supported by an earlier report of repeated breaks at 3p21.1, in fact this was the most common lesion site in this study of chromosomal aberrations of male homosexuals and the authors even considered the probability of "a new type of chromosome marker". Furthermore, years later the CKR5 structural gene was mapped to human chromosome 3p21. This gene codes for the chemokine receptor 5 (CKR5) protein which serves as a secondary receptor on CD4+ T lymphocytes for certain strains of HIV-1. It is possible that this gene was being transcribed in HIV+ men and the consequent "staggering" of DNA contributed to the production of gaps and breaks at 3p21.     

Differential effects of migration and deportation on HIV infection among male and female injection drug users in Tijuana, Mexico

HIV prevalence is rising, especially among high risk females in Tijuana, Baja California, a Mexico-US border city situated on major migration and drug trafficking routes. We compared factors associated with HIV infection among male and female injection drug users (IDUs) in Tijuana in an effort to inform HIV prevention and treatment programs. IDUs aged > or = 18 years were recruited using respondent-driven sampling and underwent testing for HIV, syphilis and structured interviews. Logistic regression identified correlates of HIV infection, stratified by gender. Among 1056 IDUs, most were Mexican-born but 67% were born outside Tijuana. Reasons for moving to Tijuana included deportation from the US (56% for males, 29% for females), and looking for work/better life (34% for females, 15% for males). HIV prevalence was higher in females versus males (10.2% vs. 3.5%, p = 0.001). Among females (N = 158), factors independently associated with higher HIV prevalence included younger age, lifetime syphilis infection and living in Tijuana for longer durations. Among males (N = 898), factors independently associated with higher HIV prevalence were syphilis titers consistent with active infection, being arrested for having 'track-marks', having larger numbers of recent injection partners and living in Tijuana for shorter durations. An interaction between gender and number of years lived in Tijuana regressed on HIV infection was significant (p = 0.03). Upon further analysis, deportation from the U.S. explained the association between shorter duration lived in Tijuana and HIV infection among males; odds of HIV infection were four-fold higher among male injectors deported from the US, compared to other males, adjusting for all other significant correlates (p = 0.002). Geographic mobility has a profound influence on Tijuana's evolving HIV epidemic, and its impact is significantly modified by gender. Future studies are needed to elucidate the context of mobility and HIV acquisition in this region, and whether US immigration policies adversely affect HIV risk.     

Don’t Throw it Away!

This historical narrative tracks the evolution and devolution of visual arts education from Dewey's progressive era pedagogy and the theory of the arts as experience through the modern accountability movement. Archival material, state curricular documents, and conversations with policymakers show an increasing focus on core subject areas of reading, writing, and mathematics at the expense of arts education. Texas House Bill 3, the third generation of accountability legislation in the Lone Star State, provides a case study of the status of arts education after more than fifteen years of high-stakes testing and accountability. Policy considerations are offered for arts education and its future standing within the public educational curriculum.