Suchergebnisse

This volume offers a range of perspectives on these and other lessons learned, with essays on the science, politics, and ethics of the Ebola outbreak.The contributors discuss topics including the virology and management of EVD in both rich .

Strategies for HIV prevention among infants, children, and adolescents have evolved significantly over the past 20 years. These include the global scale-up of simplified multidrug HIV regimens for pregnant women, leading to impressive reductions in new child HIV infections. However, significant gaps remain, especially in high HIV-burden sub-Saharan African countries. For example, many pregnant women living with HIV (WLHIV) are unable to access and sustain HIV testing and treatment partly due to low agency and harmful gender norms. Among pregnant WLHIV, adolescent girls face an additional layer of societal and health-system barriers in accessing care for themselves and their exposed infants. Legal and structural barriers limit access to HIV prevention-related sexual and reproductive health services among high-risk adolescents, including girls and young men who have sex with men. Key ethical issues underlying HIV prevention gaps for infants, children, and adolescents prevail. This narrative review explores these issues and highlights counter-measures for programming and policy, including gender empowerment, improving access to and appropriateness of critical health services, rights-based policy and legislation, closing research gaps, and considering the values and preferences of young people for HIV prevention and treatment services.

Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through "herd immunity", which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian Government has determined that rates should be higher, and has recently introduced policy that includes involved removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection to vaccination ("No Jab No Pay"). In addition, it has raised the possibility of banning unvaccinated children from childcare centres ("No Jab No Play"). This article examines the impact of coercive approaches to childhood vaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhood vaccination in Australia, the small but real risks associated with vaccination, the ethical requirement for consent for medical procedures and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices.

The new MTV generation- Using Meth, Truvada, and Viagra to stay safe and enhance sex: Results from the Flux StudyHammoud MA1*, Vaccher S1*, Bridget H1, Lea T2, Maher L1, Jin F1, Bourne A3, and Prestage GP11The Kirby Institute, UNSW Sydney, Australia 2 Centre for Social Research in Health, UNSW Sydney, Australia3 Australian Research Centre in Sex, Health and Society, La Trobe University, Australia* Indicates joint first authorBackground: Concurrent use of methamphetamine and erectile dysfunction medication (EDM; most commonly, Viagra) is associated with HIV seroconversion among gay and bisexual men (GBM). Truvada (and its generic formulations), used for HIV pre-exposure prophylaxis (PrEP), is an effective biomedical HIV prevention strategy. Anecdotally, GBM engaging in intensive sex partying use these drugs to enhance sexual pleasure and longevity, and reduce HIV-related anxiety. We compared men who used Methamphetamine, Truvada, and Viagra (MTV) with those who used methamphetamine and EDM, but not PrEP.Methods: Flux is an online cohort study of drug use among 1,720 Australian GBM. Logistic regression was used to determine characteristics associated with MTV use. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) are reported. Results: Mean age at baseline was 33.7 years. In the six months prior to baseline, 34.8% used EDM and 13.1% used methamphetamine; 33.8% of men who used EDM also used methamphetamine. PrEP use increased from 0.8% at baseline in June 2015 to 14.2% at last follow-up in March 2017. During this time, men reported 1056 periods in which they used both methamphetamine and EDM but not PrEP, and 172 periods in which they reported MTV. In periods when men used MTV, they were more likely to report condomless anal intercourse with casual partners (aOR 2.51, 95%CI 1.5-4.2) and group sex (aOR 1.78, 95%CI 1.1-2.9), compared with periods when they used methamphetamine and EDM but not PrEP. Having more gay friends was also associated with MTV use (aOR 1.67, 95%CI 1.3-2.2).Conclusion: MTV use was associated with higher-risk sexual practices and greater social connection with gay community. MTV demonstrates an attempt to simultaneously reduce HIV risk and enhance sexual pleasure within gay sexual subcultures. Targeted harm reduction initiatives need to raise awareness of potential behavioural and physiological impacts of combining these drugs.Disclosure of Interest Statement: The Kirby Institute, the Centre for Social Research in Health, and the Australian Research Centre in Sex, Health and Society are supported by the Australian Government Department of Health. The Flux study was funded by an Australian Research Council Discovery Project. No pharmaceutical grants were received in the conduct of this study.