Correlates of HIV testing among abused women in South Africa.

Gender-based violence increases a woman's risk for HIV but little is known about her decision to get tested. We interviewed 97 women seeking abuse-related services from a nongovernmental organization (NGO) in Johannesburg, South Africa. Forty-six women (47%) had been tested for HIV. Caring for children (odds ratio [OR] = 0.27, 95% confidence interval [CI] = [0.07, 1.00]) and conversing with partner about HIV (OR = 0.13, 95% CI = [0.02, 0.85]) decreased odds of testing. Stronger risk-reduction intentions (OR = 1.27, 95% CI = [1.01, 1.60]) and seeking help from police (OR = 5.51, 95% CI = [1.18, 25.76]) increased odds of testing. Providing safe access to integrated services and testing may increase testing in this population. Infection with HIV is highly prevalent in South Africa where an estimated 16.2% of adults between the ages of 15 and 49 have the virus. The necessary first step to stemming the spread of HIV and receiving life-saving treatment is learning one's HIV serostatus through testing. Many factors may contribute to someone's risk of HIV infection and many barriers may prevent testing. One factor that does both is gender-based violence.

Outposts of Empire: Scientific Discovery and Colonial Displacement in Gaskell's Wives and Daughters

This article offers a fresh consideration of Elizabeth Gaskell's unfinished Wives and Daughters (1864–6), in terms of what this metropolitan novelist knew about contemporary scientific debates and imperial exploration of Africa, and how her familiarity with these discourses was incorporated into her imaginative work. Her focus for these two related themes is the naturalist Roger Hamley, whose character and exploits are meant to parallel those of the young Charles Darwin. Roger's direct involvement in the historical Geoffroy–Cuvier debate allows Gaskell to offer a sophisticated examination of how discussions about evolutionary biology (about which she learned from personal acquaintances and printed sources) contributed to political and social change in the era of the first Reform Bill. Roger's subsequent journey to Abyssinia to gather specimens allows Gaskell to form a link between science and imperial exploration, which demonstrates how, when carried to its conclusion, the development of classificatory knowledge systems was never innocent; rather, it facilitated colonial exploitation and intervention, which allowed for the ‘opening up of Africa’. Gaskell's pronouncements about science in the novel are far more explicit than her brief references to empire; the article ponders why this should be so, and offers some suggestions about how her reliance on imaginative and discursive constructs concerning the ‘Dark Continent’ may be interpreted as tacit complicity with the imperial project, or at least an interest in its more imaginative aspects.

Cognitive-behavioural interventions for children who have been sexually abused

Background: Despite differences in how it is defined, there is a general consensus amongst clinicians and researchers that the sexual abuse of children and adolescents (’child sexual abuse’) is a substantial social problem worldwide. The effects of sexual abuse manifest in a wide range of symptoms, including fear, anxiety, post-traumatic stress disorder and various externalising and internalising behaviour problems, such as inappropriate sexual behaviours. Child sexual abuse is associated with increased risk of psychological problems in adulthood. Cognitive-behavioural approaches are used to help children and their non-offending or ’safe’ parent tomanage the sequelae of childhood sexual abuse. This review updates the first Cochrane review of cognitive-behavioural approaches interventions for children who have been sexually abused, which was first published in 2006.

Objectives: To assess the efficacy of cognitive-behavioural approaches (CBT) in addressing the immediate and longer-term sequelae of sexual abuse on children and young people up to 18 years of age.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2011 Issue 4); MEDLINE (1950 to November Week
3 2011); EMBASE (1980 to Week 47 2011); CINAHL (1937 to 2 December 2011); PsycINFO (1887 to November Week 5 2011); LILACS (1982 to 2 December 2011) and OpenGrey, previously OpenSIGLE (1980 to 2 December 2011). For this update we also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP).

Selection criteria: We included randomised or quasi-randomised controlled trials of CBT used with children and adolescents up to age 18 years who had experienced being sexually abused, compared with treatment as usual, with or without placebo control.

Data collection and analysis: At least two review authors independently assessed the eligibility of titles and abstracts identified in the search. Two review authors independently extracted data from included studies and entered these into Review Manager 5 software. We synthesised and presented data in both written and graphical form (forest plots).

Main results: We included 10 trials, involving 847 participants. All studies examined CBT programmes provided to children or children and a nonoffending parent. Control groups included wait list controls (n = 1) or treatment as usual (n = 9). Treatment as usual was, for the most part, supportive, unstructured psychotherapy. Generally the reporting of studies was poor. Only four studies were judged ’low risk of bias’ with regards to sequence generation and only one study was judged ’low risk of bias’ in relation to allocation concealment. All studies were judged ’high risk of bias’ in relation to the blinding of outcome assessors or personnel; most studies did not report on these, or other issues of bias. Most studies reported results for study completers rather than for those recruited.

Depression, post-traumatic stress disorder (PTSD), anxiety and child behaviour problems were the primary outcomes. Data suggest that CBT may have a positive impact on the sequelae of child sexual abuse, but most results were not statistically significant. Strongest evidence for positive effects of CBT appears to be in reducing PTSD and anxiety symptoms, but even in these areas effects tend to be 'moderate’ at best. Meta-analysis of data from five studies suggested an average decrease of 1.9 points on the Child Depression Inventory immediately after intervention (95% confidence interval (CI) decrease of 4.0 to increase of 0.4; I2 = 53%; P value for heterogeneity = 0.08), representing a small to moderate effect size. Data from six studies yielded an average decrease of 0.44 standard deviations on a variety of child post-traumatic stress disorder scales (95% CI 0.16 to 0.73; I2 = 46%; P value for heterogeneity = 0.10). Combined data from five studies yielded an average decrease of 0.23 standard deviations on various child anxiety scales (95% CI 0.3 to 0.4; I2=0%; P value for heterogeneity = 0.84). No study reported adverse effects.

Authors’ conclusions: The conclusions of this updated review remain the same as those when it was first published. The review confirms the potential of CBT to address the adverse consequences of child sexual abuse, but highlights the limitations of the evidence base and the need for more carefully conducted and better reported trials.

The Psychological and Health Consequences of Caring for a Spouse With Dementia:A Critical Comparison of Husbands and Wives

Caring for someone with dementia can be demanding, particularly for spouses living with the care recipient. The main goal of this study was to clarify differences in the experience of caregivers who were husbands and wives with respect to burden, health, healthy behaviors, presence of difficult care recipient behaviors, social supports, and the quality of the premorbid relationship. The results of this study support research demonstrating a difference between the caregiving experiences of women and men. It is becoming increasingly apparent that female gender is a marker that places them at increased risk of high burden and less support.

From 'trailing wives' to the emergence of a 'trailing husbands' phenomenon: Retirement migration to rural areas

Migration and gender studies have focused on economically active heterogeneous couples and traditionally highlight a dominant male role in migration decision-making. The female partner is commonly portrayed as a 'trailing wife' or 'trailing mother' with the move found to have a negative effect on her employment prospects. Much less is known about if or how the balance of power shifts between husbands and wives when employment or career-motivated moves are removed from the decision-making process. This is analysed with reference to retirement migration to rural areas of the UK and involved interviews with both partners present. For this cohort of retired couples, and in common with the literature, migration during economically active life course stages demonstrates strong 'trailing wife' and 'trailing mother' tendencies. The male's decision to retire signalled the commencement of a retirement life course stage for the couple. However, in contrast to the earlier male dominated decision-making, retirement migration saw the emergence of a 'trailing husband' phenomenon. Wives appear to adapt most successfully to the new rural environment while many husbands found it difficult to adjust (at least initially) to the multiple life changes: moving from largely urban areas to a rural setting alongside exiting the workforce. The findings suggest that the role of leader/ follower changed during the course of these couples' lives together and in relation to their reasons for moving.

Defrauding Daughters Turning Deviant Wives? Reading Female Agency in The Merchant of Venice

Brabantio’s words “Look to her, Moor, if thou hast eyes to see:| She has deceived her father, and may thee” ( Othello , 1.3.292–293) warn Othello about the changing nature of female lo yalty and women’s potential for deviancy. Closely examining d aughters caught in the conflict between anxious fathers and husbands-to- be, this article departs from such paranoid male fa ntasy and instead sets out to explore female deviancy in its legal and dramatic implications with reference to Shakespeare ’s The Merchant of Venice . I will argue that Portia’s and Jessica’s struggle to evade male subsidiarity results in their conscio us positioning themselves on the verge of illegality. Besides occa sioning productive exploration of marriage, law and justice within what Morss (2007:183) terms “the dynamics of human desir e and of social institutions,” I argue that female agency, s een as temporary deviancy and/or self-exclusion, reconfigures the ma le domain by affording the inclusion of previous outsiders (Anto nio, Bassanio and Lorenzo) .

Exploring the experiences of male spousal caregivers for their wives with alzheimer disease in their homes : the lived experience and the men's perception of support groups /

This research is qualitative in nature and has explored, by means of interviews, the '^^ experiences of 10 men in their roles in caring for their spouses with Alzheimer Disease (see glossary) in their homes. Additional data were collected by attending 3 formal support group meetings and one informal meeting of a group of men who brought their wives to a support group meeting for their wives with AD. The data retrieved supported the assumption that education about the disease, utilization of formal community support services, and attendance at caregiver support groups or programs can assist healthy male caregivers in caring for their wives with AD in their homes.

The development, assessment, and implementation of an evaluation of the EMPOWER Program at shelters for abused women /

The development, assessment, and implementation of a program evaluation instrument was carried out to evaluate the impact and efficacy of the EMPOWER Program. This intervention was created to educate residents at a shelter for abused women with an anticipated outcome of prevention. Participants included the staff and residents at 2 shelters in Southern Ontario. Client pre, post and follow-up measures were obtained and analyzed statistically and using keyword content analysis. A single staff measure was obtained and summarized using keyword content analysis. Qualitative results were suggestive of important change in participants. All women in the post and follow-up measures believed their participation in the EMPOWER Program provided them with the knowledge, skills, and confidence to avoid abusive relationships in the fliture. This transformational impact was repeatedly expressed in both resident and staff feedback. Limitations of this research, as well as suggestions for future study were discussed.