Suchergebnisse

The common wisdom in journalistic accounts of earmarking is that Congress distributes earmarks on a purely political basis, without any consideration for the demand for federal spending. Academic accounts similarly argue that factors internal to Congress are preeminent in determining where earmarks go, even more than for other types of pork‐barrel spending. Using earmarks appearing in the fiscal year 2008 Appropriations bills, I search for both chamber‐based and demand‐side determinants of the distribution of earmarks. I find that both types of factors are significantly related to the number of earmarks that a House member receives. This result indicates that even while earmarking, members of Congress are at least minimally responsive to voter preferences and calls into question whether earmarks should be treated as an outlier within the universe of spending allocation mechanisms.

Politically experienced challengers are more successful in seeking political office than amateurs. The relationship is found so regularly that political experience has become the standard ex ante indicator of challenger quality in studies of American elections. Despite this, little work has investigated why experienced challengers are so successful. Many scholars attribute the relationship to inherent differences between experienced challengers and amateurs: experienced challengers have stronger electoral skills and greater access to material resources. I argue that these differences play a role, but an indirect one. Rather, experienced challengers are lead by both their resource advantage and the high amount of risk they are exposed to in seeking office to run in races in which their party has a good chance of winning. Thus, the direct cause of the experienced challengers'success is self-selection into winnable races. Empirical analysis supports the self-selection model over a model in which resources directly lead to success. Adapted from the source document.

Introduction An estimated 2.4 [1.8–3.2] million people in the WHO European Region now live with HIV, and none of the Region's 53 countries have been spared. The epidemic is spreading most rapidly in western Europe among migrants and men who have sex with men, and in eastern Europe among male injecting drug users – and increasingly their sexual partners. This doctoral research investigates several aspects of HIV epidemiology and treatment in the European Region that inform the global commitment to provide universal access to HIV prevention, treatment, care and support services. Concretely, it aims to: • assess two migrant populations' knowledge of and attitudes towards HIV/AIDS (Paper I), and evaluate the equity of injecting drug users' access to HIV treatment in the Region (Paper II); • track the Region's two principal HIV coinfections, hepatitis C (Paper III) and tuberculosis (Paper IV); • analyse the effect of health care reforms on potential HIV health care providers in Estonia, the country with the highest HIV prevalence in the European Union (Paper V); and • measure the impact of individual and societal factors on condom use in young people across the Region (Paper VI). Methods The methods utilised included logistic regression, semi-structured interviews and a nominal group technique (I, V), multi-country data collection, descriptive epidemiology and policy analysis (II, III, IV) and multilevel analysis (VI). Results The six papers illuminate a range of equity, policy, knowledge and health systems issues. • Paper I found that in the migrant populations studied, general knowledge about HIV/AIDS, and condom use specifically, particularly among women, was especially deficient. • Paper II showed that for injecting drug users, access to antiretroviral treatment was inequitable, particularly in eastern Europe. • Paper III revealed that, in countries where the HIV epidemic is driven by injecting drug use, coinfection with hepatitis C ranges from 10% to 80%. It noted that, overall, access to hepatitis treatment is still very limited in Europe due to poor surveillance, high costs and countries' failure to recognise hepatitis as a critical health issue. • Among TB patients tested in 25 countries, Paper IV found that 3.3% were HIV-positive. The male-to-female ratio of the coinfected group was 2.7:1, with the largest percentage of coinfections being reported in people aged 25-34 (48%). Though recommended TB/HIV policies have been implemented in many European countries, the paper emphasised that what is needed most is strengthened coordination between TB and HIV programmes. • In Estonia, Paper V showed that the health sector reforms of the 1990s did not take advantage of its many midwives to address the major HIV epidemic that was emerging. • Paper VI demonstrated correlations between a variety of individual and contextual variables – such as alcohol use, predominant national religion and socioeconomic indicators – and young Europeans' condom use. Conclusions In Europe, where HIV/AIDS is often a high priority and the means to combat it are widely available, transmission patterns remain misunderstood and the epidemiology has many gaps. That there still exist "hidden" epidemics, hidden HIV issues and inequitable responses in the European Region today reflects, in part, the status of the groups most at risk and the poor state of surveillance – of HIV, AIDS and their comorbidities such as hepatitis and tuberculosis. This, in turn, impedes effective prevention, treatment, care and support efforts. Research that exposes such blind spots – whether in epidemiology, policy or implementation – can identify key challenges in responding to this epidemic and suggest concrete ways to address them.