Denial Of Risk Research Articles

Vulnerability to climate change and the variations in factors affecting farmers’ adaptation: A multi-group structural equation modelling study

This study investigates how factors that influence farmers’ intentions to adapt to climate change differ from each other in regions with different levels of vulnerability to climate change. Data were collected from interviews with 598 rice farmers in Dong Thap, Soc Trang and Long An provinces in the Mekong Delta, Vietnam. These provinces were identified respectively as highly, moderately and mildly vulnerable to climate change. Multi-group structural equation modelling was employed. There are some differences regarding factors that influence farmers’ adaptation intentions and the magnitude of the diverse influences across the three provinces. Perceived risks of climate change and perceived influences of the increases in electricity, water and fuel prices significantly influence farmers’ adaptation intentions only in Long An. Soc Trang farmers are significantly influenced by the pressures from other people in adaptation intentions. Denial of climate change risk, wishful thinking and fatalism significantly affect farmers’ adaptation intentions in both Dong Thap and Long An. The perceived effectiveness of adaptive measures is important to adaptation intentions in all provinces. Thus, vulnerability levels do matter to factors affecting farmers’ intentions to adapt. However, the influences of these factors on adaptation intention are not significantly different across the three regions. This may imply a minor difference in the vulnerability levels of the three regions. Local farmers are either not aware of their vulnerability levels; or vulnerability is not an important factor guiding farmers’ adaptation intentions. Some policy implications are drawn for formulating more effective adaptation strategies.

On the concept of denial of natural hazard risk and its use in relation to householder wildfire safety in Australia

Denial has often been used to explain why some residents at risk from natural hazards do not take appropriate threat mitigation actions. However, there has been little critical discussion of the concept of denial in relation to natural hazards. We examined the origins and development of the concept and noted that denial, as an explanation for inaction, is an inferred construct, not an observable phenomenon. We reviewed accounts that proposed denial as an explanation for residents failing to mitigate their natural hazard risk. We concluded that the concept has been used so inconsistently as to be meaningless without an explanation of the intended sense of the term. We discuss findings from reports of post-event interviews with residents threatened by severe Australian wildfires, and from a survey of agency community safety senior managers. The reports indicated that small percentages of residents in high-risk communities could be described as perhaps being in denial. The survey found that none of the wildfire agencies employed the concept formally. We suggest that it may be more useful to view most householders' failures to mitigate their wildfire risk as resulting from potential threats being entwined with more immediate higher priority competing demands of everyday life.

Difficulties experienced by veterinarians when communicating about emerging zoonotic risks with animal owners: the case of Hendra virus.

BackgroundCommunication skills are essential for veterinarians who need to discuss animal health related matters with their clients. When dealing with an emerging zoonosis, such as Hendra virus (HeV), veterinarians also have a legal responsibility to inform their clients about the associated risks to human health. Here we report on part of a mixed methods study that examined the preparedness of, and difficulties experienced by, veterinarians communicating about HeV-related risks with their clients.MethodsPhase 1 was an exploratory, qualitative study that consisted of a series of face-to-face, semi-structured interviews with veterinary personnel from Queensland, Australia (2009–10) to identify the barriers to HeV management in equine practices. Phase 2a was a quantitative study that surveyed veterinarians from the same region (2011) and explored the veterinarians’ preparedness and willingness to communicate about HeV-related risks, and the reactions of their clients that they experienced. The second study included both multiple choice and open-ended questions.ResultsThe majority of the participants from Phase 2a (83.1%) declared they had access to a HeV management plan and over half (58.6%) had ready-to-use HeV information available for clients within their practice. Most (87%) reported “always or sometimes” informing clients about HeV-related risks when a horse appeared sick. When HeV was suspected, 58.1% of participants reported their clients were receptive to their safety directives and 24.9% of clients were either initially unreceptive, overwhelmed by fear, or in denial of the associated risks. The thematic analysis of the qualitative data from Phases 1 and 2a uncovered similar themes in relation to HeV-related communication issues experienced by veterinarians: “clients’ intent to adhere”; “adherence deemed redundant”; “misunderstanding or denial of risk”; “cost”; “rural culture”; “fear for reputation”. The theme of “emotional state of clients” was only identified during Phase 1.ConclusionWarning horse owners about health and safety issues that may affect them when present in a veterinary work environment is a legal requirement for veterinarians. However, emerging zoonoses are unpredictable events that may require a different communication approach. Future training programs addressing veterinary communication skills should take into account the particular issues inherent to managing an emerging zoonosis and emphasise the importance of maintaining human safety. Veterinary communication skills and approaches required when dealing with emerging zoonoses should be further investigated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-017-0970-2) contains supplementary material, which is available to authorized users.

Attitudes towards human papillomavirus vaccination among African parents in a city in the north of England: a qualitative study.

BackgroundHuman papillomavirus (HPV) is sexually transmitted and has been conclusively linked to cervical cancer and genital warts. Cervical cancer is attributed to approximately 1100 deaths annually in UK, and is the second most common female cancer globally. It has been suggested that black African women are more predisposed to HPV infection and cervical cancer. A vaccine has been developed to reduce HPV infection, and in the UK, has been offered to 12–13 year old adolescent girls through schools as part of their childhood immunization programme since 2008. Upon programme initiation, it was noted that vaccine uptake was lower in schools where girls from ethnic minority groups were proportionately higher.The study’s objectives were to explore factors influencing UK based African parents’ acceptance or decline of the HPV vaccine, whether fathers and mothers share similar views pertaining to vaccination and any interfamily tensions resulting from differing views.MethodsA qualitative study was conducted with five African couples residing in north England. Face to face semi-structured interviews were carried out. Participants were parents to at least one daughter aged between 8 and 14 years. Recruitment was done through purposive sampling using snowballing.ResultsHPV and cervical cancer awareness was generally low, with awareness lower in fathers. HPV vaccination was generally unacceptable among the participants, with fear of promiscuity, infertility and concerns that it’s still a new vaccine with yet unknown side effects cited as reasons for vaccine decline. There was HPV risk denial as religion and good cultural upbringing seemed to result in low risk perceptions, with HPV and cervical cancer generally perceived as a white person’s disease. Religious values and cultural norms influenced vaccine decision-making, with fathers acting as the ultimate decision makers. Current information about why the vaccine is necessary was generally misunderstood.ConclusionTailored information addressing religious and cultural concerns may improve vaccine acceptability in African parents.

Refusal of Medical Blood Transfusions Among Jehovah's Witnesses: Emotion Regulation of the Dissonance of Saving and Sacrificing Life.

This study focuses on the requirement of JWs to refuse medical blood transfusions. We identified a life-death cognitive dissonance among JWs, with the opposing cognitions of being willing to sacrifice life by religious standards, while being unwilling to do so. Using a theory that connects cognitive dissonance with the need to regulate difficult emotions to analyze our qualitative data material, we identified two sets of dissonance reduction strategies among the JWs. Set 1 was tied to the individual-group: selective focus on eternal life, a non-blood support and control system, and increased individualization of treatment choices. Set 2 was in the religion versus medicine intersection: denial of risk combined with optimism, perception of blood as dangerous, and use of medical language to underscore religious doctrine.

Overseas Filipino workers in conflict zones: narratives of Filipino nurses in Libya

This paper examines the risk perception of Filipino nurses who worked in Libya during the height of post-2011 crisis. The narratives reveal that Filipino nurses took advantage of the massive hiring campaign organized by Libya’s Ministry of Health in 2012, hoping that their migration experiences would result in economic and social rewards as they established their careers in the healthcare industry. After 2 years of adjustment to the conflict-ridden environment, they found themselves situated in another episode of civil war, once again defying the Philippine government’s mandatory repatriation program. Guided by Carretero’s (Risk-taking in unauthorised migration, 2008) thesis, we observed the mechanism of defiance that entails risk-taking as the political crisis loomed. Filipino nurses, especially those who initially refused to leave Libya, embraced an “illusion of control” that eventually reinforced an “unrealistic optimism.” These risk-minimizing strategies have successfully undermined the protective powers of the state. The paper argues that Filipino migrants in crisis zones like Libya undertake risk calculation and reduction, albeit with a tendency to commit risk denial and a false sense of empowerment and exceptionality. In the end, however, it is emphasized that these mechanisms have limitations, depending on the experiences, timing, and risk interpretation of the migrants.

Denial of risk: The effects of positive impression management on risk assessments for psychopathic and nonpsychopathic offenders

Risk assessments for offenders often combine past records with current clinical findings from observations, interviews, and test data. Conclusions based on these risk assessments are highly consequential, sometimes resulting in increased criminal sentences or prolonged hospitalization. Therefore, many offenders are motivated to intentionally minimize risk factors and their negative consequences. Positive impression management (PIM) is especially likely to occur in offenders with high psychopathic traits because goal-directed deception is reflected in several of psychopathy's core traits of the disorder, such as manipulativeness, glibness, and superficial charm. However, this connection appears to be based on the conceptual understanding of psychopathy, and has rarely been examined empirically for either frequency of or success at deception. The current study examined the ability of a jail sample to intentionally minimize risk factors and related criminal attributes using a repeated measures, simulation design. In general, offenders were able to effectively use PIM to lower scores on the HCR-20 and the Self-Appraisal Questionnaire (SAQ), while the Psychological Inventory of Criminal Thinking Styles (PICTS), as a measure of cognitive styles, was more resistant to such minimization. Psychopathic traits, especially high Factor 1 scores (i.e., affective/interpersonal), were associated with greater PIM. Important differences in the willingness and ability to use deception were found based on the (a) mode of administration (i.e., interview vs. self-report) and (b) level of psychopathy as measured by the Psychopathy Checklist — Revised (PCL-R). The important implications of this research are discussed for risk assessment procedures regarding likely areas of deception and its detection. The current research also informs the growing literature on the connection between psychopathic traits and deception.

Risk Denial and Socio-Economic Factors Related to High HIV Transmission in a Fishing Community in Rakai, Uganda: A Qualitative Study.

BackgroundIn Kasensero fishing community, home of the first recorded case of HIV in Uganda, HIV transmission is still very high with an incidence of 4.3 and 3.1 per 100 person-years in women and men, respectively, and an HIV prevalence of 44%, reaching up to 74% among female sex workers. We explored drivers for the high HIV transmission at Kasensero from the perspective of fishermen and other community members to inform future policy and preventive interventions.Methods20 in-depth interviews including both HIV positive and HIV negative respondents, and 12 focus-group discussions involving a total of 92 respondents from the Kasensero fishing community were conducted during April-September 2014. Content analysis was performed to identify recurrent themes.ResultsThe socio-economic risk factors for high HIV transmission in Kasensero fishing community cited were multiple and cross-cutting and categorized into the following themes: power of money, risk denial, environmental triggers and a predisposing lifestyle and alcoholism and drug abuse. Others were: peer pressure, poor housing and the search for financial support for both the men and women which made them vulnerable to HIV exposure and or risk behavior.ConclusionsThere is a need for context specific combination prevention interventions in Kasensero that includes the fisher folk and other influential community leaders. Such groups could be empowered with the knowledge and social mobilization skills to fight the negative and risky behaviors, perceptions, beliefs, misconceptions and submission attitudes to fate that exposes the community to high HIV transmission. There is also need for government/partners to ensure effective policy implementation, life jackets for all fishermen, improve the poor housing at the community so as to reduce overcrowding and other housing related predispositions to high HIV rates at the community. Work place AIDS-competence teams have been successfully used to address high HIV transmission in similar settings.

Development of a hematology/oncology ICD-10 documentation job aid.

Conversion to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) was mandated for October 1, 2014, but was delayed by one year. ICD-10 accommodates newly developed diagnoses and procedures and is expected to help measure quality of care. When implemented, it will impact oncology practices because of conversion costs, loss of productivity, and billing problems. Clinical documentation must meet the specificity required by ICD-10 codes or risk denial of payments, which are projected to dramatically increase. In preparation for the now delayed conversion, the ICD-10 transition team at the Seattle Cancer Care Alliance (SCCA) examined the ICD-10 codes for primary hematology/oncology diagnoses and comorbidities of cancer and therapy seen at our institution to identify the need for and feasibility of developing a printable job aid to guide clinical documentation. We found that the variable complexity of ICD-10 codes in hematology/oncology frequently requires nonintuitive specificity likely to be overlooked without prompting. We were able to develop a succinct and facile documentation aid usable in both electronic and printed forms that includes all hematology/oncology diagnoses and the comorbidities most frequently seen in our multidisciplinary institution. This document is organized in a notebook format for easy review and will be continuously improved with feedback from practitioners. It is available for free download from the SCCA Web site.

Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis.

BackgroundHai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices.MethodsFifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants’ understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used.ResultsQualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend’s home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management, punitive attitudes, fear of arrest/imprisonment, lack of resources, incorrect self-assessment, and risk denial. Some of the IDU participants emphasised self-care attitudes which should be encouraged to minimise HIV transmission risk.ConclusionThe IDUs’ experiences in Hai Phong identified through our data broaden our qualitative understanding about the HIV transmission risk among IDUs and emphasize the need to strengthen harm reduction services in Vietnam.

Food and Nutrition Hazards Related to Public Health, Food Technology and Ecology: Perceptions of Experts and Non-experts in the United Kingdom

Aim: This study investigated perceptions of risk to self, risk to society, risk denial, control, responsibility, trust and knowledge of food and nutrition-related hazards among expert and nonexpert groups with an aim of better understanding barriers to effective communication between experts and the public. Design: Participants completed a questionnaire housed on an online platform. Methodology: Experts were recruited from nutritionists in the food industry in the UK. Non-experts were recruited from a voluntary public panel with access to the online platform. Questions documented demographic variables and scores for the risk that food and nutrition-related hazards pose to self and society. Participants scored perceptions of expert and personal control of hazards, personal responsibility for averting the hazards, trust in experts for managing the hazards and personal knowledge of the hazards. The hazards were categorised for analysis into public nutrition, food technology and food ecology to reflect degrees of citizen participation in risk management. Results: Experts scored perception of risk to self and risk to society from food technology hazards significantly lower than non-experts. Both groups had greatest risk denial, scores of personal control, personal responsibility and personal knowledge, and lowest scores for expert control, for public nutrition hazards. Trust in experts was higher among experts than it was among nonexperts. Gender, personal responsibility and knowledge, but not trust in experts, were significant predictors of risk perception. Conclusions: There were similarities in perception of risk of public nutrition and food ecology Original Research Article Bahra and Mullen; EJNFS, 5(3): 166-178, 2015; Article no.EJNFS.2015.016 167 hazards between experts and non-experts, but differences in the perception of risk and trust in experts relating to food technology. Both groups perceived higher personal control of and personal responsibility for, and lower expert control for, public nutrition hazards.

The Battle for Baghdad: Testing Hypotheses About Insurgency From Risk Heterogeneity, Repeat Victimization, and Denial Policing Approaches

The Iraqi Insurgency (2003–2011) has commonly been characterized as demonstrating the tendency for violence to cluster and diffuse at the local level. Recent research has demonstrated that insurgent attacks in Iraq cluster in time and space in a manner similar to that observed for the spread of a disease. The current study employs a variety of approaches common to the scientific study of criminal activities to advance our understanding of the correlates of observed patterns of the incidence and contagion of insurgent attacks. We hypothesize that the precise patterns will vary from one place to another, but that more attacks will occur in areas that are heavily populated, where coalition forces are active, and along road networks. To test these hypotheses, we use a fishnet to build a geographical model of Baghdad that disaggregates the city into more than 3000 grid cell locations. A number of logistic regression models with spatial and temporal lags are employed to explore patterns of local escalation and diffusion. These models demonstrate the validity of arguments under each of three models but suggest, overall, that risk heterogeneity arguments provide the most compelling and consistent account of the location of insurgency. In particular, the results demonstrate that violence is most likely at locations with greater population levels, higher density of roads, and military garrisons.

‘Check it out!’ Decision-making of vulnerable groups about participation in a two-stage cardiometabolic health check: A qualitative study

ObjectiveExploring determinants influencing vulnerable groups regarding (non-) participation in the Dutch two-stage cardiometabolic health check, comprising a health risk assessment (HRA) and prevention consultations (PCs) for high-risk individuals. MethodsQualitative study comprising 21 focus groups with non-Western (Surinamese, Turkish, Moroccan) immigrants aged 45–70, adult children from one of these descents, native Dutch with a lower socioeconomic status, and healthcare professionals working with these groups. ResultsReasons for not completing the HRA included (flawed) risk perceptions, health negligence, (health) illiteracy, and language barriers. A face-to-face invitation from a reliable source and community outreach to raise awareness were perceived as facilitating participation. Reasons for not attending the PCs overlapped with completing the HRA but additionally included risk denial, fear about the outcome, its potential consequences (lifestyle changes and medication prescription), and disease-related stigma. ConclusionReasons for not completing the HRA were mainly cognitive, whereas reasons for not attending the PCs were also affective. Practice implicationsWhen designing a two-stage health check, choice of invitation method seems important, as does training healthcare professionals in techniques to effectively handle patients’ (flawed) risk perceptions and attitudinal ambivalence. Focus should be on promoting informed choices by providing accurate information.

Factors perceived to influence risky sexual behaviours among university students in the United Kingdom: a qualitative telephone interview study.

BackgroundIn the United Kingdom people under the age of 25 years are at increased risk of contracting sexually transmitted infections. Most university students belong to this age group but little is known about their sexual behaviours. The aim of the study was to explore university students’ perspectives of factors and mechanisms that influence risky sexual behaviours among university students in the United Kingdom.MethodsAll students at a university in a northern city of England were invited via email to participate in qualitative telephone interviews. Interviews were audio recorded and transcribed verbatim. Framework analytical approach was used.ResultsTwenty interviews were conducted with a diverse sample of students. The social context of university lifestyle was perceived to affect risky sex through high levels of alcohol consumption, increased sexual opportunities, liberation from moral surveillance and expectations of the stereotypical highly sexually active student. Individual and cultural differences were also perceived to account for some patterns of risky sex with older students, overseas students and religious students perceived to be less likely to engage in risky sex due to academic priorities and a tendency to be more likely to adhere to moral values. Risk denial was also a key factor that led students to engage in risky sex. Poor access to sexual health services including inconvenient opening times, lack of confidentiality and stigma were perceived to contribute to the limited use of sexually transmitted infections testing and contraceptive services.ConclusionsLifestyle, individual and structural factors seem to play an important role in influencing the risky sexual behaviours of university students. Therefore preventive interventions that focus on these factors could be very useful in this sub-population of young people. This study provides useful baseline information that helps us understand how and why some United Kingdom university students engage in risky sexual behaviours that puts them at risk of contracting sexually transmitted infections.

Replicating cluster subtypes for the prevention of adolescent smoking and alcohol use

IntroductionSubstance abuse interventions tailored to the individual level have produced effective outcomes for a wide variety of behaviors. One approach to enhancing tailoring involves using cluster analysis to identify prevention subtypes that represent different attitudes about substance use. This study applied this approach to better understand tailored interventions for smoking and alcohol prevention. MethodsAnalyses were performed on a sample of sixth graders from 20 New England middle schools involved in a 36-month tailored intervention study. Most adolescents reported being in the Acquisition Precontemplation (aPC) stage at baseline: not smoking or not drinking and not planning to start in the next six months. For smoking (N=4059) and alcohol (N=3973), each sample was randomly split into five subsamples. Cluster analysis was performed within each subsample based on three variables: Pros and Cons (from Decisional Balance Scales), and Situational Temptations. ResultsAcross all subsamples for both smoking and alcohol, the following four clusters were identified: (1) Most Protected (MP; low Pros, high Cons, low Temptations); (2) Ambivalent (AM; high Pros, average Cons and Temptations); (3) Risk Denial (RD; average Pros, low Cons, average Temptations); and (4) High Risk (HR; high Pros, low Cons, and very high Temptations). ConclusionsFinding the same four clusters within aPC for both smoking and alcohol, replicating the results across the five subsamples, and demonstrating hypothesized relations among the clusters with additional external validity analyses provide strong evidence of the robustness of these results. These clusters demonstrate evidence of validity and can provide a basis for tailoring interventions.

Use of the Carolina HPV Immunization Attitudes and Beliefs Scale (CHIAS) in young adult women.

BackgroundValidated measures that can accurate describe young adults’ HPV vaccination attitudes and how these relate to vaccination intention and receipt are needed for developing interventions to improve low HPV vaccination levels. The Carolina HPV Immunization Attitudes Scale (CHIAS) is a validated measure of these outcomes that was originally designed for parents.ObjectiveTo assess the performance of the CHIAS among young adult women using an exploratory factor analysis.MethodsA convenience sample of 139 young adult women (age 18–26 years) were given the CHIAS measure at baseline. Factor analysis was used to determine attitudinal factor groupings and the association of these factors with HPV vaccination intention. A 6-month follow up assessment examined the stability of the CHIAS over time and the association of baseline vaccine factors with vaccine receipt.ResultsFive factors loaded on to the CHIAS in young adults - “Barriers,” “Harms,” “Effectiveness,” “Risk Denial” and “Uncertainty,” - which was similar to the factor loadings of CHIAS for parents. “Harms” was the factor most consistently associated with vaccination intention at all time points assessed. Only 5 women had received or made an appointment to receive the vaccine at the 6-month follow-up.ConclusionsIn terms of categorizing HPV vaccination attitudes, the CHIAS appears to have similar performance among young adults as in parents. However, additional studies are needed to assess the utility of the CHIAS for predicting HPV vaccine receipt among the young adult population.

Smokers' risk perception, socioeconomic status and source of information on cancer

BackgroundIn many countries, the decline in smoking prevalence has coincided with a growing concentration of smoking among people with lower socioeconomic status (SES). This concentration may reflect the social differentiation of risk perceptions. We investigated the factors associated with risk perception and fear of cancer, paying particular attention to SES indicators and health information seeking. MethodologyA cross-sectional telephone survey conducted in France in 2010 (including 826 current smokers aged 18–75) assessing how smokers perceive the risk of smoking-related cancer in terms of daily consumption and duration thresholds. ResultsAmong current smokers, 38% considered that smoking can cause cancer only for a daily consumption higher than their own consumption, and an additional 22% stated that tobacco-related cancer risk only becomes high for a longer smoking duration than their personal one. Predictors of such risk perceptions included low SES, material deprivation and mentioning either the internet or their relatives as one's main source of information on cancer. The same characteristics were also predictive of personal fear of tobacco-related cancer. ConclusionOur results illustrate the challenges faced by prevention campaigns in the internet society, as information found on the web may fuel smokers' risk denial. Anti-tobacco policies should tailor interventions to people with low SES, who may be especially impervious to standard prevention campaigns because of material deprivation, and they should also address and challenge smokers' risk denial beliefs.

HIV testing practices as reported by HIV-infected patients in four European countries

HIV testing constitutes an important strategy to control the HIV epidemic, which therefore merits an observation of HIV testing practices to help improve testing effectiveness. In 2008, a cross-sectional survey among recently diagnosed (≤ 3 years) HIV-infected patients was conducted in Belgium, Estonia, Finland and Portugal. Participants were questioned about reasons for HIV testing, testing place and testing conditions. Univariate and multivariate analyses were performed. Out of 1460 eligible participants, 629 (43%) were included. Forty-one per cent were diagnosed late and 55% had never undergone a previous HIV test with perceived low risk being the primary reason for not having been tested earlier. Heterogeneity in HIV testing practices was observed across countries. Overall, tests were most frequently conducted in primary care (38%) and specialised clinics (21%), primarily on the initiative of the health care provider (65%). Sixty-one per cent were tested with informed consent, 31% received pretest counselling, 78% received post-test counselling, 71% were involved in partner notification and 92% were in care three months after diagnosis. The results showed that HIV testing is done in a variety of settings suggesting that multiple pathways to HIV testing are provided. HIV testing practice is being normalised, with less focus on pretest counselling, yet with emphasis on post-test follow-up. Major barriers to testing are centred on the denial of risk. Efforts are needed to concurrently promote public awareness about HIV risk and benefits of HIV testing and train clinicians to be more proactive in offering HIV testing.

Abnormal weather events in 2009, increased precipitation and disastrous impacts in the Philippines

The Philippines has recently experienced distinct changes in the weather patterns with disastrous results. These changes which were distinctly felt in 2009 included: 1. too much precipitation throughout the year; 2. some areas received a lot of rain while other parts of the country went through dry spell and drought conditions; and 3. abnormalities and variance in weather patterns (e.g. multiple entry of a tropical cyclone during an El Nino event; longer duration of tropical cyclone; deviations from the normal tropical cyclone path). The country, with its disaster risk management program in place, has managed to bring down the cost of damage and number of casualties due to weather-related disasters. However, in some instances, disaster risk response was made difficult due to other factors (e.g. degraded ecosystem, ill-managed land use and risk denial by people and communities). In general though, the resiliency and ability to recover by the people devastated by these disasters and the availability of community-based support systems provided the best means of coping with these catastrophic events. This is important as climate change is projected to bring more variations in the country’s weather and climate patterns which, as of now, are already adversely affecting the people.

HIV-related Stigma in Rural and Tribal Communities of Maharashtra, India

Stigma is a recognized barrier to early detection of HIV and causes great suffering for those affected. This paper examines HIV-related stigma in rural and tribal communities of Maharashtra, an area of relatively high HIV prevalence in India. The study used a mix of qualitative and quantitative methods to compare adult women and adolescents in a rural area, women in a rural area, and women in a tribal area. The respondents included 494 married women and 186 adolescents in a rural community and 49 married women in six tribal villages. HIV-related stigma was prevalent in all communities and was the highest among tribal and older respondents. High-risk behaviour was reported in both areas, accompanied with denial of personal risk. Our findings suggest that HIV may be spreading silently in these communities. To our knowledge, this is the first community-based study to make an in-depth assessment of HIV-related stigma in rural and tribal areas of India. By situating our findings within the broader discourse on stigma in the national and state-level data, this study helps explain the nature and persistence of stigma and how to address it more effectively among subcultural groups in India.