Non-marital Partners Research Articles

Impact of natural disasters on HIV risk behaviors, seroprevalence, and virological supression in a hyperendemic fishing village in Uganda.

Understanding the impact of natural disasters on the HIV epidemic in populations with high HIV burden is critical for the effective delivery of HIV control efforts. We assessed HIV risk behaviors, seroprevalence, and viral suppression in a high HIV prevalence Lake Victoria fishing community before and after COVID-19 emergence and lockdown and a severe lake flooding event, both of which occurred in 2020. We used data from the largest Lake Victoria fishing community in the Rakai Community Cohort Study, an open population-based HIV surveillance cohort in south-central Uganda. The data were collected both prior to (September-December 2018) and after (October-December 2021) COVID-19 emergence and a severe flooding event. Households impacted by flooding were identified via drone data and through consulting village community health workers. The entire study population was subject to extensive COVID-19-related lockdowns in the first half of 2020. Differences in HIV-related outcomes before and after COVID, and between residents of flooded and non-flooded households, were assessed using a difference-in-differences statistical modeling approach. A total of 1,226 people participated in the pre- and post-COVID surveys, of whom 506 (41%) were affected by flooding. HIV seroprevalence in the initial period was 37% in flooded and 36.8% in non-flooded households. After the COVID-19 pandemic and lockdown, we observed a decline in HIV-associated risk behaviors: transactional sex declined from 29.4% to 24.8% (p = 0.011), and inconsistent condom use with non-marital partners declined from 41.6% to 37% (p = 0.021). ART coverage increased from 91.6% to 97.2% (p<0.001). There was 17% decline in transactional sex (aPR = 0.83, 95% CI: 0.75-0.92) and 28% decline in the overall HIV risk score (aPR = 0.83, 95% CI: 0.75-0.92) among HIV-seronegative participants. We observed no statistically significant differences in changes of HIV risk behavior, seroprevalence, or viral suppression outcomes when comparing those affected by floods to those not affected by floods, in the periods before and after COVID-19, based on difference-in-differences analyses. Despite a high background burden of HIV, the COVID-19 pandemic, and severe flooding, we observed no adverse impact on HIV risk behaviors, seroprevalence, or virologic outcomes. This may be attributed to innovative HIV programming during the period and/or population resilience. Understanding exactly what HIV programs and personal or community-level strategies worked to maintain good public health outcomes despite extreme environmental and pandemic conditions may help improve HIV epidemic control during future natural disaster events.

Characteristics of and Factors Associated With Partner Service Uptake Cascade Among People With Newly Reported HIV/AIDS Diagnoses in Southeastern China in 2022: Cross-Sectional Survey.

HIV notification and testing integrated into partner service (PS) practices among HIV-positive individuals have been proven to be an efficient approach for case finding, although it remains a weak link in China. Although nonmarital sexual activities accounted for a large proportion of newly diagnosed HIV-positive cases in China, little is known about PS uptake and associated factors within nonmarital partnerships. This study aimed to describe HIV PS utilization and its associated factors among HIV-positive individuals with nonmarital sexual partners. We recruited newly diagnosed HIV-positive individuals who had nonmarital sexual partners in 2022 in Zhejiang Province and offered them PS. We described the PS uptake cascade within sexual partner categories and analyzed the associated factors with 3 primary outcomes from the participants' perspective: nonmarital partner enumeration, HIV testing, and HIV positivity. In this study, 3509 HIV-positive individuals were recruited as participants, and they enumerated 2507 nonmarital sex partners (2507/14,556, 17.2% of all nonmarital sex partners) with contact information. Among these, 43.1% (1090/2507) underwent an HIV test, with an HIV-positive rate of 28.3% (309/1090). Heterosexual commercial partners were the least likely of being enumerated (441/4292, 10.3%) and had the highest HIV-positive rate (40/107, 37.4%). At the participant level, 48.1% (1688/3509) of the participants enumerated at least one nonmarital sex partner with contact information, 52.7% (890/1688) had a sex partner tested for HIV, and 31% (276/890) had at least one nonmarital sex partner who tested positive. Multivariate analysis indicated that gender and transmission route were associated with both nonmarital sex partner enumeration and HIV testing. Age and occupation were associated with nonmarital sex partner enumeration and HIV positivity. Compared with participants who had no regular nonmarital sex partner, those who had a regular nonmarital sex partner were more likely to enumerate nonmarital sex partners (adjusted odds ratio [aOR] 3.017, 95% CI 2.560-3.554), have them get tested for HIV (aOR 1.725, 95% CI 1.403-2.122), and have an HIV-positive nonmarital sex partner (aOR 1.962, 95% CI 1.454-2.647). The percentage of partner enumeration was low, and HIV testing rate was moderate among nonmarital partnerships of HIV-positive individuals. More efforts should be made to improve PS practices among HIV-positive individuals and address the gap in partner enumeration, especially for heterosexual commercial nonmarital partnerships. Additionally, enhancing PS operational skills among health care personnel could increase the overall efficiency of PS uptake in China.

Leaving the parental home, cohabitation, and marriage after a hematologic malignancy in childhood-A register-based cohort study from the SALiCCS research program.

Transitioning to adulthood often involves achieving independence from the parental home. We assessed whether the likelihood of leaving the parental home, cohabitation, and marriage was similar between patients who experienced a hematologic malignancy at a young age and their peers. We identified 11,575 patients diagnosed with a hematologic malignancy under the age of 20 years between 1971 and 2011 in Denmark, Finland, and Sweden, 57,727 country-, age-, and sex-matched population comparisons and 11,803 sibling comparisons and obtained annual information on family and marital status by linking to the statistical institute databases. Hazard ratios (HR) for leaving the parental home, cohabitation and marriage were estimated using Cox proportional hazards modeling. Young adults with a history of a hematologic malignancy were slightly less likely to leave the parental home (HR 0.89; 95% confidence interval [CI] 0.86-0.92; HR 0.87 [95% CI 0.82-0.92]), cohabit with a nonmarital partner (HR 0.83 [95%CI 0.78-0.87]; HR 0.84 [95% CI 0.77-0.92]) and be married (HR 0.87 [95% CI 0.82-0.91]; HR 0.86 [95% CI 0.79-0.93]), compared with population comparisons and siblings, respectively. Our findings provide reassurance that young adults with a history of a hematologic malignancy show only a slight decrease in their likelihood of gaining independence from their childhood family and forming close interpersonal relationships compared to peers. While most patients are coping well in the long term, integrating structured psychosocial support into long-term follow-up is recommended to facilitate a timely and adequate transition into adulthood.

Comparative Analysis of Property Rights of Non-Marital Partners in North Macedonia and Selected European Union Countries

Abstract In recent years in North Macedonia, there has been a noticeable and steady rise in the prevalence of non-marital unions or domestic partnerships, alongside a decline in the number of marriages and an increase in divorces. This trend mirrors developments seen across Europe, signaling significant shifts in the perception, function, and role of the institution of marriage and family over recent decades. Across European nations, various models of legal frameworks govern non-marital unions. These differences encompass conditions for existence and legal recognition, the legal consequences of domestic partnership, and procedures for its dissolution. While some countries require registration and fulfillment of specific criteria for legal recognition and effects of non-marital unions, others, like North Macedonia, do not impose such prerequisites. In certain jurisdictions, the legal ramifications of non-marital unions closely resemble those of marriage, encompassing both personal and property rights between non-marital partners. However, in the Republic of North Macedonia, the law predominantly focuses on regulating property relations between such partners, granting them certain rights—a focal point of this research paper. The legal framework governing the property relations of non-marital partners holds significant importance, particularly in safeguarding the financial security of economically vulnerable partners and ensuring the protection of any shared children. The methods employed in this research include theoretical analysis and the comparative method, drawing upon the legal frameworks and practices of Croatia, France, and Italy alongside North Macedonia. Through these analytical approaches, we aim to elucidate the intricate dynamics of domestic partnerships and their implications for individuals and families in contemporary society.

Gender differences in the association of dementia symptoms severity and hospital anxiety

IntroductionSymptoms of anxiety can worsen cognitive decline in people with dementia, and symptoms of dementia and fears of further cognitive decline can cause anxiety. Advanced dementia is not necessarily associated with a loss of emotion, which means that people may still experience anxiety, but their ability to cope in a healthy way is reduced. The problem is exacerbated by the fact that hospital care alone can contribute to the severity of anxiety symptoms due to change in routine of daily activities, unfamiliar surroundings, uncertainty about health status, prognosis and various medical procedures. There are differences between women and men in the prevalence, course and manifestation of both dementia and anxiety disorders.ObjectivesTo examine whether there are differences between women and men in the association of hospital anxiety with eight symptoms of dementia: difficulties with memory, orientation, judgement, problem solving, fulfilling social obligations, daily activities at home and with hobbies, or personal care, in patients with mild to moderate dementia.Methods A cross-sectional study was conducted at Sveti Ivan Psychiatric Clinic in Zagreb in June 2023. The target population were hospitalised patients diagnosed with dementia, both genderes, aged 60-90 years, without psychotic disorder. Anxiety during hospitalisation was measured using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the severity of dementia symptoms was measured using the Dementia Assessment Instrument (CDR). The hypothesis was tested using Wald test of differences between women and men in unstandardised linear regression coefficients of the HADS-A on individual dementia symptoms, after adjustment for age, education, presence of a married or stable non-marital partner and duration of current hospitalisation.ResultsWe enrolled 65 women and 35 men of comparable age. There were significant gender-related differences in the association between hospital anxiety and difficulties with judgement (P = 0.01), fulfilling social obligations (P &lt; 0.001), difficulties with home and hobbies (P = 0.02), and personal care (P = 0.00). In women, more pronounced difficulties with judgement and with home and hobbies were associated with higher anxiety, and in men the presence of these two symptoms of dementia was associated with lower anxiety. Difficulties with fulfilling social obligations are associated with lower anxiety in women and higher anxiety in men. Difficulties with personal care were associated with lower anxiety in both genders, but this effect was stronger in men.ConclusionsThere are differences between women and men in the association between anxiety during hospital treatment and the severity of individual dementia symptoms. These differences are present in difficulties with judgement, fulfilling social obligations, home, hobbies and personal care.Disclosure of InterestNone Declared

Partnership Status, Health, and Mortality: Selection or Protection?

Married individuals have better health and lower mortality than nonmarried people. Studies show that when cohabitants are distinguished from other nonmarried groups, health differences between partnered and nonpartnered individuals become even more pronounced. Some researchers have argued that partnered individuals have better health and lower mortality because a partnership offers protective effects (protection); others have posited that partnered people have better health and lower mortality because healthy persons are more likely to form a union and less likely to dissolve it (selection). This study contributes to this debate by investigating health and mortality by partnership status in England and Wales and analyzing the causes of mortality differences. We use combined data from the British Household Panel Survey and the UK Household Longitudinal Study and apply a simultaneous-equations hazard model to control for observed and unobserved selection into partnerships. We develop a novel approach to identify frailty based on self-rated health. Our analysis shows that partnered individuals have significantly lower mortality than nonpartnered people. We observe some selection into and out of unions on unobserved health characteristics, but the mortality differences by partnership status persist. The study offers strong support for the marital protection hypothesis and extends it to nonmarital partnerships.

Exploring Factors Shaping Primary Health Care Readiness to Respond to Family Violence: Findings from a Rapid Evidence Assessment

Abstract Purpose Family violence (FV) is defined as any situation where an individual employs abusive behaviour to control and/or harm a former or current spouse, non-marital partner, or a member of their family. The health consequences of FV are vast, including a wide range of physical and mental health conditions for individuals experiencing violence or survivors, perpetrators, and their children. Primary health care (PHC) is recognized as a setting uniquely positioned to identify the risk and protective factors for FV, being an entry point into the health care system and a first, or only, point of contact for families with professionals who can facilitate access to specialist care and support. Methods A rapid evidence assessment of empirical studies on FV interventions in PHC was conducted to examine outcomes of effective FV interventions that promote identification, assessment, and care delivery within diverse PHC settings, factors shaping PHC provider and system readiness, and key intervention components that are important for sustaining PHC responses to FV. After completing data extraction, quality appraisal, and a hand search, a total of 49 articles were included in data synthesis and analysis. Results Several FV interventions that include multiple components such as, screening and identification of FV, training of PHC providers, advocacy, and referrals to supports, have been rigorously tested and evaluated in diverse PHC settings in rural and urban areas including primary care/family medicine practice clinics and community PHC centers. These interventions have demonstrated to be effective in identifying and responding to violence primarily experienced by women. There is a dearth of FV interventions or programs from empirical studies focused on men, children, and perpetrators. Additionally, provider and system readiness measurement tools and models have been implemented and evaluated in PHC specifically to assess physician or the health care team’s readiness to manage FV in terms of knowledge and awareness of FV. The findings highlight that there is no clear or standardized definition of provider or system “readiness” in the literature related to FV responses in PHC. Further, the findings revealed four key intervention components to facilitate PHC provider and organization readiness to address FV: (1) multidisciplinary teamwork and collaboration, (2) improving provider knowledge on the social and cultural determinants impacting FV, and (3) embedding system-level supports within PHC. Conclusions FV is a serious public health concern and PHC providers have a vital role in early detection of FV and the poor health outcomes associated with violence A focus on comprehensive or multi-component FV interventions are more likely to change provider behavior, and would allow for safe, confident, and professional identification and assessment of FV within PHC.

Partnership dynamics and entry into parenthood: Comparison of Finnish birth cohorts 1969-2000.

During the past decade, the stability of close-to-replacement-level fertility ended in all Nordic countries, with its decline to the lowest level in Finland. It is unclear whether and how partnership dynamics have changed, and whether they play a role in fertility developments. We focus on the patterns and associations between the formation and stability of co-residential partnerships and first birth among Finnish women and men, and on whether and how these associations have changed across birth cohorts. We utilise total population register data on persons born between 1969 and 2000 in Finland, and adopt the event history method. Our results indicate that half of the women formed their first co-residential partnerships by the age of 22 years. Cohorts born in the early 1990s were the first to delay the formation of non-marital first partnerships. In contrast, first births are increasingly postponed, and the proportion of women and men, who become parents, has declined across recent cohorts. Among men, we observe higher median ages for family formation events and higher likelihoods of not forming a family. As a result of fertility decline and increase in partnership instability, for the first time, the probability of separation is higher than that of first births among partnered women born in the 1990s. Our findings show that at a behavioural level, the once close link between partnership formation and parenthood has progressively eroded across consecutive birth cohorts. Together with the ongoing tendency to delay first births, decreasing partnership stability, and first indications of delaying partnership formation, the potential of witnessing a marked increase of fertility levels in the near future is delimited. Our study's results contribute to a better understanding of the demographic mechanisms behind the decline in fertility in Finland, over the recent decade.

Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70).

Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)-defined as having biological children with more than one partner, with obesity at midlife. The sample consisted of 2940 fathers and 3369 mothers in the 1970 British Cohort Study. The outcome was obesity (BMI 30 or over) at age 46. Fertility and partnership histories ascertained the number of live biological children and MPF status by age 42. The associations were tested using logistic regression adjusting for confounders at birth, age 10 and age 16. Adult factors recorded at age 42 including age at first birth, smoking status, alcohol dependency, educational attainment and housing tenure were considered as mediators. For fathers, obesity odds did not differ according to number of children or MPF. In unadjusted models, mothers with one child (OR 1.24 95%CI 1.01-1.51), mothers who had two children with two partners (OR 1.45 95%CI 1.05-1.99), and mothers who had three or more children with two or more partners (OR 1.51 95%CI 1.18-1.93) had higher odds of obesity. In adjusted models, there remained an association between mothers with one child and odds of obesity (OR 1.30 95%CI 1.05-1.60). All other associations were attenuated when confounders were included. Mothers who had children with multiple partners had higher odds of obesity. However this association was completely attenuated when parental and child confounders were accounted for; suggesting that this association may be explained by confounding. Mothers who had one child only may be at increased odds of obesity, however this could be due to multiple factors including age at first birth.

Association between educational attainment and risky sexual behaviour among Ghanaian female youth.

Ghanaian female youth aged 15-24 years are especially vulnerable to sexually transmitted infections (STIs) compared to their male counterparts. This study examined the association between educational attainment and risky sexual behavior among Ghanaian female youth. A cross-sectional study was conducted using a nationally representative sample of youth from the 2014 Ghana Demographic and Health Survey (n=1702). The outcome of interest was risky sexual behavior, defined as having last intercourse with a non-marital partner without condoms. Descriptive and inferential statistical tests were utilized. Overall, the prevalence of risky sexual behavior was 66.9%. In the bivariate analysis, risky sexual behavior differed by level of education. Compared to women with a college-level education, a significantly higher proportion of women with secondary education reported risky sexual behavior (72.9%), followed by those with primary education (65.7%) (p<0.001). In the multivariable-adjusted model, there was a significant interaction between education and household wealth index (P =0.030) and between education and the type of place of residence (P =0.045) on risky sexual behavior. Culturally appropriate and targeted interventions are warranted to increase condom use among these subgroups and curb the rising rates of STIs among Ghanaian female youth.

Reflections on the Sinicization of the French Civil Mutual Aid Contract PACS System

The French PACS system has been implemented for more than 20 years to protect the rights of non-marital partners. The phenomenon of non-marital cohabitation is becoming a social reality in China. Non-marital cohabitation will lead to issues related to the identity of the parties, division of property, and child support. Therefore, in line with the main purpose of facing social reality, protecting the rights of non-marital cohabiting partners, and stabilizing social life, China should include non-marital cohabitation in the scope of family law adjustment. Because there is no relevant legislation on the protection of the rights and interests of cohabiting partners in China before this, this article starts from three perspectives: the development history of the French PACS system, the possibility of the Sinicization of the PACS system, and the significance of the Sinicized PACS system to the development of Chinese society. By discussing the similarities and differences between China and France on the conclusion procedure, property distribution, and dispute resolution in the cohabitation relationship, the proposal of the Chinese PACS system is proposed.

Does a longer sexual resume affect marriage rates?

Sociologists have proposed numerous theories for declining marriage rates in the United States, often highlighting demographic, economic, and cultural factors. One controversial theory contends that having multiple non-marital sex partners reduces traditional incentives for men to get married and simultaneously undermines their prospects in the marriage market. For women, multiple partners purportedly reduces their desirability as spouses by evoking a gendered double-standard about promiscuity. Though previous studies have shown that having multiple premarital sex partners is negatively associated with marital quality and stability, to date no research has examined whether having multiple non-marital sex partners affects marriage rates. Data from four waves of the National Survey of Family Growth reveal that American women who report more sex partners are less likely to get married by the time of the survey (though so too were virgins). Yet this finding is potentially misleading given the retrospective and cross-sectional nature of the data. Seventeen waves of prospective data from the National Longitudinal Survey of Youth's 1997 mixed-gender cohort that extend through 2015 show the association between non-marital sex partners and marriage rates is temporary: recent sex partners predict lower odds of marriage, but not lifetime non-marital sex partners. Seemingly unrelated bivariate probit models suggest the short-term association likely reflects a causal effect. Our findings ultimately cast doubt on recent scholarship that has implicated the ready availability of casual sex in the retreat from marriage. Rather, the effect of multiple sex partners on marriage rates is “seasonal” for most Americans.

PHARMACOTHERAPY IN THE OLDER ADULT: CHARACTERIZATION, MEDICATION ADHERENCE AND POTENTIALLY INAPPROPRIATE MEDICATIONS

Introduction: Aging is a dynamic process in which biochemical and physiological changes are related to a higher frequency of pathological processes, which ultimately lead the human being to death. Part of these alterations and pathologies are improved using medicines, so older adults are great consumers of medicines. Several instruments have been used to evaluate the use of inappropriate medications in older adults, with Beers Criteria frequently used. The concept of medication adherence has undergone changes over time and represents the degree to which the patient’s behaviour corresponds and agrees with the recommendations of a doctor or other health professional. Medication non-adherence to entails a decrease in the quality of life of the patients and high costs for the health systems. Objectives: To characterize drug therapy in older adult users of a northern Portuguese community pharmacy, as well as to identify the presence of potentially inappropriate medications (PIMs) in the older adult and to assess medication adherence. Methods: Exploratory and descriptive study. The target population was older adult users of a community pharmacy in the municipality of Valpaços, Portugal. The data collection instrument used was a questionnaire applied in the form of a structured interview. The potentially inappropriate medications (PIMs) identification was based on the most recent version of the Beers Criteria published in 2019. The MAT (Measurement of Adherence to Treatments) scale was used to evaluate medication adherence. The statistical treatment included the calculation of absolute and relative frequencies, measures of central tendency and dispersion. Results: 60 older adult people were interviewed, 53.3% of them women. The average age was 78.35 years. Among these, 55.0% were married/had a non-marital partner, 71.7% lived accompanied, 26.7% had primary school education, 40.0% received less than 300 Euros monthly and 95.0% lived in the municipality of Valpaços. Each older adult person consumes on average 6 different types of medication per day. Major polymerization was present in 66.7% of older adults, and 94.2% of the drugs being prescribed by the physician. In 34.7% of the cases, the medication had been used for at least 1 year and only 3.4% reported feeling adverse reactions. Of the total 326 drugs identified, the most prescribed pharmacotherapeutic groups were drugs acting in the cardiovascular system 27.2% and in the digestive system 24.2%. Additionally, 15 drugs classified as potentially inappropriate medication were identified in the older adult. Most of the older adults (76.7%) did not adhere to drug therapy, these being mainly females with primary education, living with a partner and less than 300 euros/month. Conclusion: Polymedication and the use of potentially inappropriate medications are common in older adults. Medication adherence is low.

Predictors of multiple sexual partners among men in Ethiopia: A multilevel analysis

Multiple sexual partnerships were one of the public health issues in the spread of high rates of sexually transmitted infections in sub-Saharan regions. An increase in the number of non-marital sexual partners can lead to a loss of satisfaction as well as other mental health repercussions such as greater rates of anxiety, depression, etc. This study examined the predictors of multiple sexual partners among men in Ethiopia. This study used 2016 nationally representative data which was conducted using a multistage stratified cluster sampling method. Multilevel binary logistic regression models were employed to estimate the predictors of multiple sexual partners among men in Ethiopia with the assistance of the STATA software. In this study 6778 participants were considered with an overall prevalence rate of multiple sexual partners of 6.5% during the 12 months preceding the survey. The findings showed that older-age, urban-resident, inconsistent use of a condom, exposure to any media, abuse of alcohol, early-time first-sex, and religion were predictors of multiple sexual partners among men in Ethiopia. The findings revealed that the prevalence rate of men's multiple sexual partners in Ethiopia was very high. Therefore, the country needs to re-examine the behavioral change strategies periodically to adapt to the contextual realities and engage relevant stakeholders. Specifically, health sectors and religious organizations should develop strategies to create awareness in society on the risk of having multiple sexual partnerships. In addition, we highly recommend stakeholders prepare risk reduction interventions that take the significant predictors of multiple sexual partners.

Stability and outcome of interracial cohabitation before and after transitions to marriage

Barriers to intermarriage are more formidable than barriers to interracial cohabitation. Relative to same-race couples, a higher share of interracial couples cohabits with their nonmarital partners. This raises the question: Does the social significance of

Marriage Apostates: Why Heterosexuals Seek Same-Sex Registered Partnerships

Same-sex marriage is now a reality across Western countries. While this was a positive achievement for the LGBTQ community, some crucial questions remain unanswered. One of these questions concerns the future of nonmarital statuses, such as domestic partnerships or civil unions. After the legalization of same-sex marriage, U.S. states are simply phasing them out. I wish to argue against this trend. Based on an original analysis of empirical data and case law, I argue that nonmarital statuses retain value for non-traditional families. In fact, states must introduce nonmarital statuses open to couples regardless of gender, including adult friends and relatives. To support this argument, I present two analyses. First, I survey empirical research showing that (1) opposite-sex couples are signing up for nonmarital statuses at increasingly high rates, where available; (2) interest in such laws is growing even among same-sex couples in countries where same-sex marriage has existed for a long time. Second, I outline the legal and theoretical justifications for extending same-sex nonmarital partnerships to all couples. To this end, I analyze recent strategic litigation in Europe initiated by heterosexual couples who sought access to nonmarital statuses reserved for same-sex couples. The analysis allows me to identify three approaches: a status recognition approach, a utilitarian approach, and a legal-pluralistic approach. Ultimately, I offer guidance to policymakers in crafting a status that would be suitable for modern couples. Families that do not tick the boxes of the traditional marital family model continue to slip under the radar of law. Resurrecting these laws can fix the problem of their legal invisibility. Please note: minor changes have been made to this article on pages 213-14, and this pdf will differ slightly from hard copies or versions available elsewhere.

Ostvarivanje i zaštita prava na porodičnu penziju vanbračnog partnera, ili šta NAM sve zakonodavac nije rekao?

The amendments to the Pension and Disability Insurance Act, enacted at the end of 2019, envisage that the right to a family pension can also be exercised by the surviving extramarital partner. Thus, extramarital partners have been equated (for the first time) with spouses in matrimonial relations. In order to be entitled to a survivor's pension, both spouses and extramarital partners must inter alia spend at least three years in marriage or extramarital union, or have a child together. The existence of an extramarital union is determined in a non-litigious proceeding. Although this statutory specification of the constitutional norm on the equality of marriage and extramarital union is praiseworthy, the authors point out that the new legal provision raises a number of issues. The situation is indisputable if a man and a woman were in an exclusive extramarital relationship that lasted for a long time, and particularly if they have at least one child together. However, in the event that one of them was in a parallel extramarital union with another person, or if the condition of gender differentiation does not exist or has ceased to exist, it raises the question how the existence of an extramarital union will be proven in non-litigious proceedings. The authors examine whether the existing legal framework provides for achieving the goal of the provision envisaged in the Pension and Disability Insurance Act, and how possible abuses of this right can be prevented in order to protect the conscientious (bona fides) users acting in good faith. Although the Serbian legislator finally decided to fully equalize marital and nonmarital unions in terms of exercising the right to a family pension, we believe that the existing solution needs to be improved in order to avoid confusion in practice and prevent possible abuses. Only the nominal introduction of the provision on the equality of married and non-marital partners with reference to the non-litigation procedure has already opened a number of questions in practice. In this paper, we point to some issues concerning the method of determining the quality of an extramarital union and the competition between two extramarital unions. An innovative solution, which would represent not only a concretization of the constitutional provision but also a qualitative contribution to the pension and disability insurance system, calls for amending the existing solution in the Pension and Disability Insurance Act, detailed regulation of the procedure for determining the existence of extramarital union as a named procedure in the Non-litigation Procedure Act, and the introspection what the legislator actually wants for and from an extramarital partner. Although it sounds like a serious task, the importance of an institution such as extramarital union certainly deserves not such an approach.

The Boundaries of Multi-Parentage

Multi-parentage has arrived. In recent years, a growing number of courts and legislatures have recognized that a child may have more than two legal parents. A number of significant societal, medical, and legal developments have contributed to the trend toward multi-parentage recognition. The traditional family structure of a married different-sex couple and their biological children currently represents only a minority of U.S. families. Stepparents, non-marital partners of legal parents, and extended family members often play a significant role in children’s lives, and it has become increasingly common for same-sex couples to welcome children into their families. In addition, advancements in assisted reproductive technology have made it possible for a greater number of parties to play a role in a child’s conception. At the same time, the law has expanded both the categories of individuals who are eligible to establish parentage and the mechanisms through which parentage can be established. While the trend in favor of multi-parentage recognition is clear, the boundaries of multi-parentage remain largely unsettled. It is imperative that in drafting their multi-parentage laws, states carefully consider how to address a number of important questions. These questions include, for example, whether each of the child’s existing legal parents must consent to the establishment of multi-parentage, what (if any) cap should be set on the number of individuals who can establish legal parentage, and how to avoid imposing a hetero- and bionormative family structure on LGBTQ+ families. After providing a detailed analysis of the complex issues involved in each of these questions, the Article sets forth a number of proposals regarding how states should address these critical questions within their multi-parentage laws.

Three Different Legal Attitudes Towards Non-Marital Cohabitation in Europe

The rising number of people “just living together”, people who are neither married nor in registered partnerships, clearly demonstrates that non-marital unions can no longer be ignored. To obtain an accurate picture of the situation of non-marital partners it was essential to conduct comparative research of multiple legal orders. This analysis threw a new light (at least from the Polish standpoint) on possible solutions to the problem of the regulation of legal aspects of “living together”. It appears that three different legal attitudes towards non-marital cohabitation may be distinguished in Europe. Firstly, there are legal orders in which by virtue of an explicit reference by the legislator – the regulations on marriage are applied to cohabitation (quasi-marriage cohabitation). Secondly, there also exist countries in which a law was adopted regulating selected aspects of actual cohabitation (implied model of cohabitation). And thirdly, there are legal orders in which any cohabitant-oriented legal regime exists.

HIV-1 genetic transmission networks among people living with HIV/AIDS in Sichuan, China: a genomic and spatial epidemiological analysis

SummaryBackgroundSpatialized HIV genetic transmission networks can help understand dynamic changes of HIV-1 at the regional level. This study aimed to combine genomic, epidemiological, and spatial data to investigate the patterns of the HIV-1 epidemic at both individual and regional levels among people living with HIV (PLWH) with virological failure of antiretroviral therapy (ART).MethodsWe evaluated the transmission patterns of 5,790 PLWH with identified pol sequences of the five main HIV-1 subtypes (B, CRF08_BC, CRF85_BC, CRF07_BC, and CRF01_AE) in Sichuan Province, China. A phylogenetic cluster was defined as a group of sequences with genetically similar HIV strains, with all phylogenetic clusters forming an HIV-1 genetic transmission network for each subtype. Logistic regression was used to identify the potential risk factors for phylogenetic clustering. Spatial analysis was applied to demonstrate the geographic patterns of phylogenetic clustering rates; intensity matrices and flow maps were made to demonstrate the intensity of transmission within and between cities.FindingsThere were 2,159 (37.3%) of 5,790 PLWH, distributed in 452 phylogenetic clusters. Some individual clinical and behavioral factors were associated with phylogenetic clustering, including a viral load of >50,000 copies/ml (OR=1.16, 95%CI=1.02-1.33), infection of other sexually transmitted diseases (OR=1.38, 95%CI=1.12-1.69), and ≥5 non-marital sexual partners (OR=1.25, 95%CI=1.03-1.51), while >3 years of treatment since the initial ART was associated with less likelihood of phylogenetic clustering (OR=0.82, 95%CI=0.70-0.97). The phylogenetic clustering rates varied regionally and were highest in the central region of Sichuan, especially for subtype CRF08_BC. The significant spatial clusters of high and low phylogenetic clustering rates were detected in the east (Dazhou for B; Zigong and Luzhou for CFR08_BC) and west (Yaan and Ganzi for CRF07_BC), respectively. The proportion of intercity transmission varied across cities from 0.14 (Yibin) and 1.00 (Ganzi). Stronger intercity transmission than average existed between some cities, e.g., between Deyang and Neijiang. CRF07_BC was the most widespread subtype between cities, and CRF85_BC (a novel HIV-1 subtype) showed strong intercity transmission (e.g., between Yibin and Guangan).InterpretationThe phylogenetic clustering rates and intercity connections of HIV-1 have varied geographically, possibly due to varying human mobility, traffic convenience, and economic activities. Our findings enhanced the understanding of the dynamics of HIV-1 transmission from individual to city level, and demonstrated a novel cross-disciplinary (epidemiological, genetic, and spatial) approach by which we identified high-risk populations and areas. Our approach could be adapted to other regions for precision public health interventions.FundingThe National Natural Science Foundation of China, Sichuan Science and Technology Program, Project of Sichuan Provincial Health Committee, Science and Technology Project of Sichuan Provincial Health Committee, Wuhan University 351 Talent Program, 2020, and the International Institute of Spatial Lifecourse Epidemiology (ISLE).