Archives

  • 2018-07
  • 2018-10
  • 2018-11
  • 2019-04
  • 2019-05
  • Myoseverin All of this does not however indicate that

    2019-04-29

    All of this does not, however, indicate that Rwanda\'s state capability is the result of fear or an outlier without wider relevance. Such conclusions diminish the professionalism, diligence, and ingenuity apparent throughout the country. Unlike many post-revolutionary governments that centralised authority and remained in power for prolonged periods, Rwanda\'s Government used technical assistance to edify its own capacity for policy making and administration while launching novel homegrown initiatives. Its government has made policy decisions based on technocratic evidence and instituted mechanisms, such as performance contracts for district governments, to inculcate accountability.
    In just under 5 months\' time, the aspiration for the next 15 years of development efforts will be signed off at the UN General Assembly in New York, USA. These Sustainable Development Goals (SDGs) are already at an advanced stage of drafting—17 ambitious goals and 169 targets (), which have been criticised even by the UN General Secretary for being too voluminous. Amid this multitude of outcomes, those pertaining to health are reduced from three Millennium Development Goals to one SDG. What does this mean for global health research? It means an opportunity. As we concern ourselves with the prominence of health in the new agenda, it\'s easy to forget that (human) development is by definition people-centred, and that living a long, healthy, and creative life is its cornerstone. The expansion of the new goals to encompass many (if not all) of the enablers of an enriched life, for our generation and for those that follow, represents an opportunity to lift ourselves out of the silos we so decry and to embrace other disciplines that underlie the purpose of our own. As the SDGs, in whatever final form they Myoseverin take, are unveiled in September, 2015, and will begin to curate a special issue on sustainable development, to be published in April, 2016. As part of this special issue, we seek original research articles that cross two or more of the key disciplines of the SDGs: poverty, nutrition, health, education, economics, gender equality, water and sanitation, energy, urban planning, conservation, and climate change. Multidisciplinary authorship is a must. The deadline is Sept 15, 2015, and submissions should be made online.
    Dick Durevall and Annika Lindskog (January, 2015) explore the association between intimate partner violence (IPV) and HIV infection in Demographic and Health Survey (DHS) data. We welcome Durevall and Lindskog\'s examination of the confluence of risk factors that might place women at risk of HIV infection, building from our earlier analysis of an overlapping set of DHS datasets, and their careful interpretation of the results they find. However, we believe that Sunita Kishor\'s interpretation of their study, in relation to our earlier study on the same question, necessitates some elaboration to ensure an accurate interpretation of this analysis. Kishor praises Durevall and Lindskog\'s use of a “clean” control group of women who have experienced no forms of IPV or male controlling behaviour in making comparisons with women who have experienced each combination of the exposures under investigation. Although this approach is informative, linkage answers a question that is fundamentally different from those addressed in previous studies, including ours, comparing all women with each exposure to the remaining sample. Durevall and Lindskog are implicitly making the case that the multiple dimensions of IPV and male controlling behaviour are intertwined and acting jointly, and that analysing their impact individually is not meaningful. This situation might well be the case, but their approach does not allow the identification of which specific exposure (ie, violence or controlling behaviour) is driving any apparent association with HIV risk. We suggest that both the “clean” approach and previously employed specifications (such as our own) are valid and useful methods for risk assessment. Kishor also offers a broad-stroke conclusion: that Durevall and Lindskog\'s work confirms that “women who experience intimate partner violence have an increased risk of being HIV positive”. In fact, their pooled analysis finds a significant association between IPV and HIV in three high HIV prevalence countries, but not elsewhere, for women experiencing both violence and male controlling behaviour. Rather than concluding that IPV and HIV are inextricably linked, we read Durevall and Lindskog\'s findings as highlighting an emerging theme in the literature: that non-negligible associations between IPV and HIV can be seen in high-prevalence settings for women in highly vulnerable situations who face many deprivations, including multiple forms of violence. Notwithstanding the fact that controlling, coercive violence has many other negative effects that make it well worth tackling for its own sake, in the context of an HIV epidemic facing resource constraints it is crucial to understand where, when, and for whom such experiences are associated with HIV, and in what settings and in which ways this association can be nullified. Drivers are likely to be found at the individual, interpersonal, and institutional levels. As Kishor notes: “what is less understood is the ‘why’ behind these associations and the direction of causality”. We agree that obtaining such knowledge will be crucial to effecting change.