Suchergebnisse

Tourism is considered one of the most sensitive sectors to climate change, which influence both demand and tourism supply, through various aspects. Climate changes can have effects on tourism, on operators and tourist destinations and on tourist flows. The importance of the topic can also be as-sessed on the basis of environmental sustainability, an issue that must be central to any public policy on the matter. The main objective of this work is the analy-sis of the effects that the climate can have on tourism, both by analyzing the forecasts of the institutions and by evaluating the operators. Finally, this work aims to analyze and evaluate public policies that can be implemented for tour-ism.

A lack of culturally appropriate healthcare is a common problem for colonial nations, and this can explain the different patterns of health in indigenous populations worldwide. Our study is the first ethnography realized with the neglected Pataxó indigenous people from the south of the state of Bahia, Brazil, that analyzes the representations and practices of "differentiated" public healthcare. The polysemic conceptualization and polymorphism of the healthcare practices highlight some spontaneous intercultural competences, particularly those of the indigenous professionals, within the hegemony of non-indigenous health knowledge and the lack of awareness of intercultural healthcare. Intercultural training and empowerment still remain a priority.

AbstractIntroductionSexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same‐sex relationships and drug‐using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy.MethodsWe systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta‐analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta‐analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates.Results and discussionOf the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta‐analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10–16%; I2 = 97.6) but higher when studies utilized self‐administered surveys (15%; 95% CI = 12–19%; p<0.05). SDU was associated with greater odds of CAI (pooled odds ratio [OR] = 3.21; 95% CI = 1.82–5.66) and living with diagnosed HIV (OR = 4.73; 95% CI = 2.27–8.21).ConclusionsSDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between‐study comparisons. Responses to SDU‐related harms should consider local contexts, including specific drug types used and their relative risks.

BACKGROUND: Given the persistence of Indigenous health inequities across national contexts, many countries have adopted strategies to improve the health of Indigenous peoples. Governmental recognition of the unique health needs of Indigenous populations is necessary for the development of targeted programs and policies to achieve universal health coverage. At the same time, the participation of Indigenous peoples in decision-making and program and policy design helps to ensure that barriers to health services are appropriately addressed and promotes the rights of Indigenous peoples to self-determination. Due to similar patterns of Indigenous health and health determinants across borders, there have been calls for greater global collaboration in this field. However, most international studies on Indigenous health policy link Anglo-settler democracies (Canada, Australia, Aotearoa/New Zealand and the United States), despite these countries representing a small fraction of the world's Indigenous people. AIM: This paper examines national-level policy in Australia, Brazil, Chile and New Zealand in relation to governmental recognition of differential Indigenous health needs and engagement with Indigenous peoples in health. The paper aims to examine how Indigenous health needs and engagement are addressed in national policy frameworks within each of the countries in order to contribute to the understanding of how to develop pro-equity policies within national health care systems. METHODS: For each country, a review was undertaken of national policies and legislation to support engagement with, and participation of, Indigenous peoples in the identification of their health needs, development of programs and policies to address these needs and which demonstrate governmental recognition of differential Indigenous health needs. Government websites were searched as well as the following databases: Google, OpenGrey, CAB Direct, PubMed, Web of Science and WorldCat. FINDINGS: Each of the four countries have adopted international ...

Context The guanaco is the largest wild herbivore inhabiting the Patagonian steppes. Since the end of the 19th Century, it has suffered a progressive decline in numbers owing to poaching and unregulated hunting because of on an assumed competition with sheep. Unfortunately, there has never been a management program for guanaco populations in Argentine Patagonia. Consequently, the guanaco is still considered a pest species by ranchers and has never been considered profitable in the range management model implemented in Patagonia. Aims The present article updates the distribution limits of guanaco and estimate its abundance across Chubut, a large province of Patagonia, Argentina. The relative effects of several environmental and anthropogenic factors on guanaco distribution are also assessed. Methods Road surveys (7010km) and species distribution modelling were used to build a habitat suitability model and a distribution map. A distance sampling method was used to estimate guanaco population densities and size. The survey effort required to monitor population trends in this region was also calculated. Key results According to the best habitat suitability model, guanaco distribution decreased with altitude and primary productivity, as measured by Normalised Difference Vegetation Index (NDVI), and increased with the distance to the nearest urban centre and oil field. Guanaco distribution showed a clear geographical pattern in Chubut, with low to medium occurrence probability towards the west and higher values towards the east. Guanaco population size was estimated as 657304 individuals (95% CI 457437 to 944059), with a mean density of 2.97 guanacos km–2. Finally, through simulations of guanaco monitoring, it was estimated that an annual survey effort of 10 to thirty 30-km road transects is needed to detect with confidence a significant population decrease or increase over the next 6 or 10 years. Conclusions The habitat suitability map presented herein highlights areas with high guanaco densities in Chubut, where it would be possible to identify ranches suitable for performing profitable herding and shearing experiences. Implications The maps of guanaco distribution and density, as well as the survey effort required to monitor population trends, may be used to inform decisions concerning the sustainable use of this species.

Context Agricultural activities have reduced wildlife natural habitats and increased the spatial overlap between animals' distribution and human activities. However, carnivores with a broad diet and flexible habitat requirements can tolerate human-induced environmental changes. Thus, identifying changes in their densities and spatial distribution are important factors to take into consideration when working towards minimising human–carnivore conflict. Aims Our aim was to identify the main environmental and human variables influencing Pampas fox density and to produce density maps in the reproductive and non-reproductive seasons. Methods We performed spotlight counts at night, following the line transect method in the non-reproductive and reproductive seasons during two consecutive years. We also obtained landscape, human-impact and environmental spatial variables using remote sensing data and Geographic Information Systems. We modelled and mapped the Pampas fox's spatial density using Density Surface Models. Key results We found that disturbance by human activities and landscape configuration influenced the spatial variation of the Pampas fox density across time and space. We registered a positive association between the number of foxes and the proximity to urban areas and paved roads, and we also found higher densities near grasslands areas and less modified habitats varying with the season and year. A higher density of foxes was observed in the non-reproductive season compared with the reproductive season. Conclusions and Implications This study provides insight on the variation in Pampas fox densities across agroecosystems. It highlights the relevance of more naturalised and protected habitats to sustain the Pampas fox population in highly fragmented landscapes, but also shows a positive association with disturbed areas. The spatial information developed in this study is useful to identify areas where ecosystem services could be encouraged, helping to maintain the ecosystems' equilibrium and biodiversity conservation, and develop new management programs creating human–wildlife coexistence.

The Lesser Rhea (Rhea pennata pennata) has suffered a marked decline in numbers over recent decades, probably mainly as a result of livestock production and overhunting. Our aim was to investigate the factors that determine the distribution of Lesser Rheas in southern Patagonia and to generate a predictive regional distribution map. We surveyed 8000 km of roads and sighted 795 Lesser Rhea individuals or flocks. We also estimated environmental predictors from remotely sensed data and analysed the occurrence of Lesser Rheas in relation to these predictors. The predictors we examined were associated with four hypotheses explaining the distribution of Lesser Rheas: the persecution by ranchers, primary productivity, topography, and anthropogenic disturbance hypotheses. We built models for each hypothesis. Our results suggest that the distribution of Lesser Rheas is not negatively affected by persecution by ranchers, as the species is more abundant in areas with high stocking levels of sheep, but is positively influenced by primary productivity and negatively by the proximity of human habitation. The resulting distribution map can be used as a management tool for government agencies and highlights the conservation priorities for managing this declining and emblematic species. ; Peer reviewed

AbstractIntroductionGay and bisexual men (GBM) are at increased risk of hepatitis C/HIV co‐infection. In Australia, the availability of subsidized direct‐acting antiviral treatment for hepatitis C has rendered eliminating co‐infection possible. High reinfection rates in subgroups with continued exposure may compromise elimination efforts. To inform the development of hepatitis C risk reduction support in GBM, we explored reinfection risk perceptions and attitudes among GBM living with HIV recently cured from hepatitis C.MethodsBetween April and August 2017, 15 GBM living with diagnosed HIV were recruited from high caseload HIV primary care services in Melbourne following successful hepatitis C treatment. In‐depth interviews were conducted exploring understandings of hepatitis C risks, experiences of co‐infection and attitudes towards reinfection. Constructivist grounded theory guided data aggregation.ResultsParticipants' understandings of their hepatitis C infection and reinfection trajectories were captured in three categories. Hepatitis C and HIV disease dichotomies: Hepatitis C diagnosis was a shock to most participants and contrasted with feelings of inevitability associated with HIV seroconversion. While HIV was normalized, hepatitis C was experienced as highly stigmatizing. Despite injecting drug use, interviewees did not identify with populations typically at risk of hepatitis C. Risk environments and avoiding reinfection: Interviewees identified their social and sexual networks as risk‐perpetuating environments where drug use was ubiquitous and higher risk sex was common. Avoiding these risk environments to avoid reinfection resulted in community disengagement, leaving many feeling socially isolated. Hepatitis C care as a catalyst for change: Engagement in hepatitis C care contributed to a better understanding of hepatitis C risks. Interviewees were committed to applying their improved competencies around transmission risk reduction to avoid reinfection. Interviewees also considered hepatitis C care as a catalyst to reduce their drug use.ConclusionsHepatitis C/HIV co‐infection among GBM cannot be understood in isolation from co‐occurring drug use and sex, nor as separate from their HIV infection. Hepatitis C prevention must address subcultural heterogeneity and the intersectionality between multiple stigmatized social identities. Hepatitis C care presents an opportunity to provide support beyond cure. Peer support networks could mitigate social capital loss following a commitment to behaviour change and reduce hepatitis C reinfection risks.

AbstractIntroductionAchieving the virtual elimination of HIV requires equitable access to HIV prevention tools for all priority populations. Restricted access to healthcare means migrants face particular barriers to HIV prevention services. In February 2016, a peer‐led rapid HIV testing service for gay, bisexual and other men who have sex with men (gay and bisexual men, GBM) in Melbourne, Australia, introduced free sexually transmissible infection (STI) testing funded through Medicare (Australia's universal healthcare system). Medicare ineligible migrant clients were required to pay up to $158AUD for STI tests. We determined the uptake of STI testing and assessed the impact on repeat HIV testing among Medicare eligible and ineligible clients.MethodsAll HIV tests conducted between August 2014 and March 2018 were included. We describe client characteristics, STI testing uptake and HIV/STI positivity among Medicare eligible and ineligible clients. Repeat HIV testing, assessed as the percentage of HIV tests with a return test within six months, was compared pre‐integration (August 2014‐June 2016) and post‐integration(July 2016‐March 2018) of STI testing using segmented linear regression of monthly aggregate data for Medicare eligible and ineligible clients.ResultsAnalyses included 9134 HIV tests among 4753 individuals. Medicare ineligible clients were younger (p < 0.01), and fewer reported previously testing for HIV (p < 0.01) and high HIV risk sexual behaviours. There was no difference in HIV positivity between the two groups (p = 0.09). STI testing uptake was significantly lower among Medicare ineligible clients (7.6%, 85.3%; p < 0.01). Following STI testing introduction there was an immediate increase in six‐month return HIV testing (6.4%; p = 0.02) and a significantly increasing rate of return HIV testing between July 2016 and March 2018 (0.5% per month; p < 0.01) among Medicare eligible clients but no immediate change in return testing (−0.9%; p = 0.7) or the rate of change in return testing between July 2016 and March 2018 (0.1% per month; p = 0.3) among Medicare ineligible clients. In March 2018, six‐month return HIV testing was 52.3% and 13.2% among Medicare eligible and ineligible clients respectively.DiscussionImprovements in return HIV testing observed among Medicare eligible clients did not extend to Medicare ineligible clients highlighting the impact of inequitable access to comprehensive sexual healthcare on test‐and‐treat approaches to HIV prevention.

Direct-acting antivirals (DAAs) have dramatically changed the landscape of hepatitis C treatment and prevention. The World Health Organization has called for the elimination of hepatitis C as a public health threat by 2030. However, the discrepancy in DAA prices across low-, middle- and high-income countries is considerable, ranging from less than US 100 to approximately US 40,000 per course, thus representing a major barrier for the scale-up of treatment and elimination. This article describes DAA pricing and pathways to accessing affordable treatment, providing case studies from Australia, Egypt and Portugal. Pathways to accessing DAAs include developing comprehensive viral hepatitis plans to facilitate price negotiations, voluntary and compulsory licenses, patent opposition, joint procurement, and personal importation schemes. While multiple factors influence the price of DAAs, a key driver is a country's capacity and willingness to negotiate with pharmaceutical companies. If negotiations do not lead to a reasonable price, governments have the option to utilise flexibilities outlined in the Agreement on Trade-Related Aspects of Intellectual Property Rights. Affordable access to DAAs is underpinned by collaboration between government, civil society, global organisations and pharmaceutical companies to ensure that all patients can access treatment. Promoting these pathways is critical for influencing policy, improving access to affordable DAAs and achieving hepatitis C elimination. ; info:eu-repo/semantics/publishedVersion

AbstractIntroductionIn Myanmar, men who have sex with men (MSM) and transgender women (TW) are disproportionately affected by HIV, despite national HIV program scale‐up. However, limited HIV surveillance capacity prevents monitoring of epidemic trends and program impact. This study aimed to estimate HIV prevalence and incidence and explore associated sexual risk behaviours among MSM and TW clients attending HIV testing clinics in Myanmar.MethodsAn electronic data management system was implemented in two community‐based, MSM and TW ‐tailored HIV testing clinics in Myanmar in August 2016. Unique client identifiers enabled prospective monitoring of service engagement, testing frequency and outcomes. We estimated HIV incidence and rate of HIV diagnosis at baseline testing visit among clients over a 15 month period. Correlates of HIV diagnoses were identified using multivariable logistic regression.Results2794 MSM and TW were tested for HIV. At their baseline test, 38% of clients reported any previous testing and 93% reported being sexually active over the previous three months, with 74% reporting sex with casual male partners and 28% reporting consistent condom use with casual partners. 291 clients tested positive for HIV for the first time at baseline (10.4%; 95% CI: 9.3 to 11.6). Twelve incident cases were detected among 279 clients receiving ≥2 tests (incidence = 10.1 per 100 person‐years; 95% CI: 5.73 to 17.8). HIV diagnosis at baseline was significantly associated with being a transgender woman or a non‐openly disclosing man who has sex with men, age 26 to 39 years, and reporting no testing history.ConclusionsHigh HIV incidence and new diagnoses being associated with reporting no testing history points to undiagnosed HIV driving transmissions in Myanmar. Repeat testing was uncommon. HIV programs in Myanmar must focus on promoting frequent HIV testing alongside adequate coverage of education and primary prevention interventions among MSM and TW.

Concern for culturally appropriate and intercultural care, based on the articulation and complementarity among health knowledges, has been a priority for ensuring primary health care for indigenous peoples since the Alma-Ata Conference. In Brazil, a country with significant sociocultural variety in the South American indigenous context, a National Policy for the Care of Indigenous Peoples (PNASPI) was established 16 years ago, focusing on the notion of differentiated care. This concept, considered incomplete and contradictory, has been variably operationalized in indigenous primary health care. Therefore, the present article proposes an analysis of the formulation and operationalization of this concept in PNASPI. The analysis brings to light the ethnocentric nature of PNASPI, the numerous contradictions and oversights that fail to encompass the interchange and articulation with traditional knowledges and the indigenous emic views of health and the processes of illness/cure. The reversal of these limitations will require greater reflexivity, problematization, and epistemological surveillance of both the social and political sciences as well as social movements and indigenous social control to redefine indigenous primary health care in Brazil in intercultural terms.