Development and validation of a data quality index for forensic documentation of sexual and gender-based violence in Kenya

Introduction

High-quality forensic documentation can improve justice outcomes for survivors of sexual and gender-based violence, but there are limited tools to assess documentation data quality. This study aimed to develop and validate a data quality assessment index to objectively assess clinician documentation across the 26 key elements of the standardized forensic evidence forms used in Kenya.

Methods

Informed by prior quality assessment tools, an initial draft of the index was developed. Feedback from Kenya- and U.S.-based clinicians and human rights experts was solicited and incorporated into the draft index in an iterative fashion. Two raters independently employed the finalized Physicians for Human Rights Data Quality Index to assess and score the quality of documentation across 31 clinician-completed forms. Inter-rater reliability was determined using Cohen kappa (к) coefficients.

Results

The Index was found to have substantial overall reliability. Of the 26 documentation items, the Index had a perfect (к = 1.0) and almost perfect (к = 0.81–0.99) level of inter-rater agreement across 17 (65.4%) and 5 (19.2%) items, respectively. On a low-to-high documentation quality scale of 0 to 2, the majority of items (n = 19, 73.1%) had a mean documentation quality score >1.5–2.

Conclusion

Quality assurance of forensic documentation is an essential component of post-sexual assault care. To our knowledge, this is the first validated quality-assessment tool in the peer-reviewed literature for sexual assault documentation and may be a promising strategy to enhance the quality of sexual assault documentation in other settings, locally, regionally, and internationally.

Social suffering and the psychological impact of structural violence and economic oppression in an ongoing conflict setting: The Gaza Strip

Structural violence and economic oppression (e.g. control over resources, politically engineered poverty and unemployment) are common features of warfare, yet there is a lack of research exploring the impact this has on civilian wellbeing in conflict-affected areas. This study, embedded within a human rights and community liberation psychology framework, aims to address this need by studying young Palestinian university graduates living under military blockade and occupation in the Gaza Strip. Semi-structured interviews were conducted. Thematic analysis indicated that economic and political domains adversely affected multiple aspects of civilian life and wellbeing. The findings revealed the deleterious effects of structural violence and economic oppression which created: human insecurity; poor psychological wellbeing and quality of life; existential, psychological and social suffering; humiliation; injuries to dignity; multiple losses; and led to life being experienced as 'on hold'. Local expressions and idioms to express distress were identified. The findings contributed to unique insights regarding how continual, systemic, and structural oppression can be potentially more psychologically detrimental than specific incidents of conflict and violence. The implications and the relevance of the findings to mental health and disaster relief are considered. Interventions providing human security and economic security should be prioritised.

Child marriage in Canada: A systematic review

Child marriage, defined by the United Nations as marriage before the age of 18, is considered a violation of human rights with negative consequences for girls' health. We systematically reviewed existing academic literature and news media to learn what is known about the frequency of child marriage in Canada and its effects on health. Approximately 1% of 15-19-year-olds in Canada were married or in common law unions in 2016. News reports document cases of child marriage among religious minority communities but no nationwide estimates of the frequency of marriage before the age of 18 were identified. Sources consistently show girls are more likely to marry as teens than boys. Information on married teens between 15 and 19 years of age suggests similarities in marriage patterns among this age group in Canada and child marriage practices globally. Further research is needed to measure Canada's progress toward eliminating child marriage.

Legal perspectives on liabilty for medical negligence and malpractices in Nigeria

Medical practice usually involves different activities which if not professionally handled, may give rise to liabilities on the part of the medical practitioner. These liabilities may arise in tortious claims and in some other cases, may go beyond the realm of civil liabilities to criminal liabilities. This review focuses on liabilities that amount to negligence both under the civil and criminal laws in Nigeria, other instances of malpractices which may not amount to negligence but may suffice to give rise to a successful cause of action in other branches of substantive law including claims for breach of fundamental human rights; contract; and fiduciary relationship. The review concludes by emphasizing the need for caution and the need to ensure that justice is seen to be done not only to the victims but also to the medical practitioners who deserve all legal protection in the exercise of their professional duties.

Is this a man's world? The effect of gender diversity and gender equality on firm innovativeness

Gender diversity is known to have a positive effect on innovation in developed countries. However, it is unclear whether the benefits of gender diversity for innovation also apply to the particular context of developing countries, which is characterized by diverse and lower levels of gender equality. We propose that gender diversity positively impacts innovation in the developing countries participating in our study. In addition, we expect that this effect is moderated by country-specific levels of gender equality. In a cross-country study covering 18,547 firms in 15 developing countries, we find that gender diversity among a firm’s owners and workforce as well as having a female top manager benefit innovation in developing countries. Yet, contradictory to our expectations, gender equality does not significantly moderate this relationship. As such, our results underline the importance of enabling and fostering gender diversity and have critical implications for firms and policy makers alike.

Evaluation of approaches to strengthen civil registration and vital statistics systems: A systematic review and synthesis of policies in 25 countries

BACKGROUND

Civil registration and vital statistics (CRVS) systems play a key role in upholding human rights and generating data for health and good governance. They also can help monitor progress in achieving the United Nations Sustainable Development Goals. Although many countries have made substantial progress in strengthening their CRVS systems, most low- and middle-income countries still have underdeveloped systems. The objective of this systematic review is to identify national policies that can help countries strengthen their systems.

METHODS AND FINDINGS

The ABI/INFORM, Embase, JSTOR, PubMed, and WHO Index Medicus databases were systematically searched for policies to improve birth and/or death registration on 24 January 2017. Global stakeholders were also contacted for relevant grey literature. For the purposes of this review, policies were categorised as supply, demand, incentive, penalty, or combination (i.e., at least two of the preceding policy approaches). Quantitative results on changes in vital event registration rates were presented for individual comparative articles. Qualitative systematic review methodology, including meta-ethnography, was used for qualitative syntheses on operational considerations encompassing acceptability to recipients and staff, human resource requirements, information technology or infrastructure requirements, costs to the health system, unintended effects, facilitators, and barriers. This study is registered with PROSPERO, number CRD42018085768. Thirty-five articles documenting experience in implementing policies to improve birth and/or death registration were identified. Although 25 countries representing all global regions (Africa, the Americas, Southeast Asia, the Western Pacific, Europe, and the Eastern Mediterranean) were reflected, there were limited countries from the Eastern Mediterranean and Europe regions. Twenty-four articles reported policy effects on birth and/or death registration. Twenty-one of the 24 articles found that the change in registration rate after the policy was positive, with two supply and one penalty articles being the exceptions. The qualitative syntheses identified 15 operational considerations across all policy categories. Human and financial resource requirements were not quantified. The primary limitation of this systematic review was the threat of publication bias wherein many countries may not have documented their experience; this threat is most concerning for policies that had neutral or negative effects.

CONCLUSIONS

Our systematic review suggests that combination policy approaches, consisting of at least a supply and demand component, were consistently associated with improved registration rates in different geographical contexts. Operational considerations should be interpreted based on health system, governance, and sociocultural context. More evaluations and research are needed from the Eastern Mediterranean and Europe regions. Further research and evaluation are also needed to estimate the human and financial resource requirements required for different policies.

Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries

CONTEXT

Although an association between gender equality and contraceptive use has been confirmed among adult samples, few studies have explored this relationship among adolescents. An examination of whether adolescents' contraceptive use is more prevalent in countries with higher levels of gender equality is needed to fill this gap.

METHODS

Nationally representative data from 33 countries that participated in the 2013-2014 Health Behaviour in School-Aged Children study and country-level measures of gender equality-using the 2014 Global Gender Gap Index-were analyzed. Multilevel multinomial logistic regression analyses were employed to assess associations between gender equality and contraceptive use (condom only, pill only and dual methods) at last intercourse as reported by 4,071 females and 4,110 males aged 14-16.

RESULTS

Increasing gender equality was positively associated with contraceptive use among both males and females. For every 0.1-point increase on the equality scale, the likelihood of condom use at last intercourse rose (odds ratio, 2.1 for females), as did the likelihood of pill use (6.5 and 9.6, respectively, for males and females) and dual method use (2.1 and 5.6, respectively). Associations with pill use and dual use remained significant after national wealth and income inequality were controlled for. Overall, associations were stronger for females than for males.

CONCLUSIONS

More research is needed to identify potential causal pathways and mechanisms through which gender equality and adolescents' contraceptive use may influence one another.

Broadening understanding of accountability ecosystems in sexual and reproductive health and rights: A systematic review

BACKGROUND

Accountability for ensuring sexual and reproductive health and rights is increasingly receiving global attention. Less attention has been paid to accountability mechanisms for sexual and reproductive health and rights at national and sub-national level, the focus of this systematic review.

METHODS

We searched for peer-reviewed literature using accountability, sexual and reproductive health, human rights and accountability instrument search terms across three electronic databases, covering public health, social sciences and legal studies. The search yielded 1906 articles, 40 of which met the inclusion and exclusion criteria (articles on low and middle-income countries in English, Spanish, French and Portuguese published from 1994 and October 2016) defined by a peer reviewed protocol.

RESULTS

Studies were analyzed thematically and through frequencies where appropriate. They were drawn from 41 low- and middle-income countries, with just over half of the publications from the public health literature, 13 from legal studies and the remaining six from social science literature. Accountability was discussed in five health areas: maternal, neonatal and child health services, HIV services, gender-based violence, lesbian/gay/bisexual/transgender access and access to reproductive health care in general. We identified three main groupings of accountability strategies: performance, social and legal accountability.

CONCLUSION

The review identified an increasing trend in the publication of accountability initiatives in Sexual and Reproductive Health and Rights (SRHR). The review points towards a complex 'accountability ecosystem' with multiple actors with a range of roles, responsibilities and interactions across levels from the transnational to the local. These accountability strategies are not mutually exclusive, but they do change the terms of engagement between the actors involved. The publications provide little insight on the connections between these accountability strategies and on the contextual conditions for the successful implementation of the accountability interventions. Obtaining a more nuanced understanding of various underpinnings of a successful approach to accountability at national and sub national levels is essential.

Kenyan Religious Leaders' Views on Same-Sex Sexuality and Gender Nonconformity: Religious Freedom versus Constitutional Rights

Religion plays an important role in framing the public discourse on sexuality, especially in countries where religion fully permeates social life. We explored the perspectives of Kenyan religious leaders on sexual and gender diversity in their country's specific context. A total of 212 Catholic, Islamic, and Protestant leaders from urban centers and rural townships completed a self-administered questionnaire specifically developed for this study. The leaders' perspectives were predominantly negative. Limited acceptance was conditional on sexual minorities not engaging in same-sex practices or seeing such practices as sinful. A substantial minority (37%) endorsed the use of violence for maintaining social values, especially regarding homosexuality and gender nonconformity. The majority of religious leaders agreed on the difference between civil law and religious doctrine. Human rights principles enshrined in Kenya's Constitution were considered to be applicable to sexual and gender minorities. Decriminalization of same-sex sexuality was seen as against one's religion. Perspectives were less negative if leaders were familiar with lesbian, gay, bisexual, and transgender (LGBT) persons. Interventions that promote intergroup contact could be effective in changing religious leaders' mind-sets and advancing human rights and health for sexual and gender minorities.

Human rights of refugee-survivors of sexual and gender-based violence with communication disability

Article 19 of the Universal Declaration of Human Rights (United Nations, 1948 ) states that all people have the right to seek, receive and impart information using any means. Ensuring that people with communication disability achieve this right is inherently challenging. For people with communication disability, who are refugee-survivors of sexual and gender-based violence (SGBV), additional human rights are challenged, including the right to education, protection from discrimination, a safe place to live, security of person and legal protection. Their experiences and needs, however, are poorly understood. This paper reports on a literature review of the intersectionality between SGBV, being a refugee and having a communication disability, and a preliminary investigation of the situation of refugee-survivors of SGBV with communication disability, in Rwanda. The project involved 54 participants, including 50 humanitarian and partner organisation staff and four carers of refugees with communication disabilities, from two locations (camp-based and urban refugees). Findings from both revealed that, for people with communication disability, barriers are likely to occur at each step of preventing and responding to SGBV. Moreover, stigmatisation of people with communication disability challenges SGBV prevention/support and people with communication disability may be targeted by SGBV perpetrators. SGBV service providers acknowledge their lack of knowledge and skills about communication disability, but wish to learn. Findings highlight the need for increased knowledge and skill development, in order to improve the situation for refugee-survivors of SGBV with communication disability.

[International experience in the legal regulation of the circulation of medicines through the prism of the law of the world trade organization]

OBJECTIVE

Introduction: The development of international legal cooperation in the field of health has largely been driven by the trade interests of states. The aim: The article analyzes the legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization.

PATIENTS AND METHODS

Materials and methods: Using the historical legal method has allowed to analyze the genesis of legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization. The dialectical method is widely used, in particular, when it comes to the issue of the ratio of market regulation of medicines circulation and public health protection, the formal logic method, in particular, in formulating the general principles, principles and methods of legal regulation in the field of medicines, as well as the systemic method, in particular, in defining the institutional component of legal regulation in the field of medicines.

RESULTS

Review: The activities of the WTO include several areas related to health protection: international control over infectious diseases, international legal regulation of food safety (food security), tobacco control, environmental protection, international legal aspects of access and treatment of medicinal and pharmaceutical products, international legal regulation of medical services provision.

CONCLUSION

Conclusions: It is proved that the right to health is a right to access to medicines. However, for many developing countries, it is problematic to obtain patents for the production of necessary medicines or to pay a license fee, which creates a barrier to the realization of the right to health.

Older and incarcerated: policy implications of aging prison populations

Purpose The purpose of this paper is to explore the policy Implications of aging prison populations. Design/methodology/approach An examination of the worldwide aging trend in prison and its implications for correctional policy, including an examination of population aging in California prisons as a case example of needed reform. Findings Prison populations worldwide are aging at an unprecedented rate, and age-related medical costs have had serious consequences for jurisdictions struggling to respond to the changes. These trends are accompanied by a growing body of evidence that old age is strongly correlated with desistance from criminal behavior, suggesting an opportunity to at least partially address the challenges of an aging prison population through early release from prison for appropriate persons. Originality/value Some policies do exist that aim to reduce the number of older, chronically ill or disabled and dying people in prison, but they have not achieved that goal on a sufficient scale. An examination of the situation in California shows that recognizing how the healthcare needs of incarcerated people change as they age - and how aging and aging-related health changes often decrease an older person's likelihood of repeat offense - is critical to achieving effective and efficient policies and practices aimed at adequately caring for this population and reducing their numbers in prisons when appropriate.

Incommunicado detention and torture in Spain, Part II: Enhanced credibility assessment based on the Istanbul Protocol

BACKGROUND

The Istanbul Protocol (IP) is the key instrument in the documentation of allegations of torture. However, few scientific studies have evaluated its effectiveness as a tool to assess credibility of allegations of ill-treatment or torture.

OBJECTIVE

Present data on the credibility of allegations of torture in a sample of 45 Basque people held in short-term incommunicado detention between 1980 and 2012, using a modified version of the Standard Evaluation Form for Credibility Assessment (SEC), a new tool to assess credibility based on the IP.

METHOD

Each case was evaluated by two psychiatrists, a psychologist and a physician through a layered system of simultaneous, independent assessments, blind audits and peer-review processes. Clinical interviews following the IP were contrasted with psychometric tests and external documentary evidence by independent experts. All available data were structured using the SEC and cases were accordingly classified as having Maximum consistency, Highly Consistent, Consistent or Inconsistent.

FINDINGS

According to the SEC, 53% of allegations of torture were considered to have Maximum Consistency, 31% Highly consistent, 15% Consistent and 0% Inconsistent. The items that most contributed to the overall credibility assessment came from the psychological evaluation, including the description of alleged torture, emotional reactions, objective functional changes, changes in identity and worldviews and clinical diagnosis. There was little contribution from previous medical reports.

INTERPRETATION

When applied competently, the IP is an essential tool in the documentation of torture. Our study shows: (a) evidence that allegations of ill-treatment and torture in the Basque Country are consistent and credible, being ascertained beyond reasonable doubt and aside from any political debate; (b) the wider use of the IP as a tool to assess credibility of allegations of ill-treatment and torture; and, (c) the usefulness of the SEC as a tool. The SEC can help as a tool for documenting torture in contexts where there are political differences and figures are distorted as a result of polarized political debates, and where legal documentation is needed for judicial purposes. Forensic science can help by providing an objective assessment of the credibility of allegations.

Incommunicado detention and torture in Spain, Part III: 'Five days is enough': the concept of torturing environments

BACKGROUND

Torture is changing in western societies, evolving from pain-producing torture to more subtle mixed psychological methods that are harder to detect. Despite this, there is not an adequate understanding of the complexities of contemporary psychological techniques used in coercive interrogation and torture.

METHODS

The interrogation and torture techniques used on 45 detainees held in short-term incommunicado detention in Spain during the period 1980-2012 were analyzed. The list of torture categories set out in the Istanbul Protocol (IP) were assessed quantitatively. Software-aided qualitative analysis of the testimonies was conducted, using both inferential and deductive approaches to deduce a classification of torture techniques from the point of view of the survivor.

FINDINGS

The most frequent methods according to the IP categories used against detainees were isolation and manipulation of environment (100%), humiliation (93%), psychological techniques to break down the individual (91%), threats (89%) and forced positions and physical exercises until extenuation (80%). Additionally, with a frequency of between 51 and 70%, mild but constant blows, being forced to witness the torture of others, hooding (mainly dry asphyxia) and unacceptable undue conditions of detention were also frequent. Sexual torture was also widespread with sexual violence (42%), forced nudity (38%) and rape (7%). Qualitative analysis showed that most detainees were submitted to coercive interrogation using a wide array of deceptive techniques. This is often a central part of the torturing process, frequently used in conjunction with many other methods. It was found that giving false or misleading information or making false accusations was most frequently used, followed by maximization of responsibility or facts and giving false information regarding relatives or friends. Different patterns of harsh interrogation, ill-treatment and torture are described that appear to have been tailored to the profile of Basque detainees.

INTERPRETATION

The study shows the need to improve the conceptualization of psychological torture suggested by the IP. Key to this view is the idea that we must not concern ourselves with 'torture methods' but with Torturing Environments. The concept of Torturing Environments is defined and proposed as a focus for future study.

Representing Human Rights Violations in Darfur: Global Justice, National Distinctions

This article examines how international judicial interventions in mass atrocity influence representations of violence. It relies on content analysis of 3,387 articles and opinion pieces in leading newspapers from eight Western countries, compiled into the Darfur Media Dataset, as well as in-depth interviews to assess how media frame violence in the Darfur region of Sudan. Overall, it finds that UN Security Council and International Criminal Court interventions increase representations of mass violence as crime in all countries under investigation, although each country applies the crime frame at a different level. Reporting suffering and categorizing the violence as genocide also varies across countries. Comparative case studies identify country specific structural and cultural forces that appear to account for these differences. Multilevel multivariate analyses confirm the explanatory power of cultural sensitivities and policy practices, while individual-and organization-level factors, such as reporters' gender and the newspapers' ideological orientation, also have explanatory power.

Health and Human Rights in Karen State, Eastern Myanmar

BACKGROUND

Decades of conflict in eastern Myanmar have resulted in high prevalence of human rights violations and poor health outcomes. While recent ceasefire agreements have reduced conflict in this area, it is unknown whether this has resulted in concomitant reductions in human rights violations.

METHODS AND FINDINGS

We conducted a two-stage cluster survey of 686 households in eastern Myanmar to assess health status, access to healthcare, food security, exposure to human rights violations and identification of alleged perpetrators over the 12 months prior to January 2012, a period of near-absence of conflict in this region. Household hunger (FANTA-2 scale) was moderate/high in 91 (13.2%) households, while the proportion of households reporting food shortages in each month of 2011 ranged from 19.9% in December to 47.0% in September, with food insecurity peaking just prior to the harvest. Diarrhea prevalence in children was 14.2% and in everyone it was 5.8%. Forced labor was the most common human rights violation (185 households, 24.9%), and 210 households (30.6%) reported experiencing one or more human rights violations in 2011. Multiple logistic regression analysis identified associations between human rights violations and poor health outcomes.

CONCLUSION

Human rights violations and their health consequences persist despite reduced intensity of conflict in eastern Myanmar. Ceasefire agreements should include language that protects human rights, and reconciliation efforts should address the health consequences of decades of human rights violations.

Sex work and the claim for grassroots legislation

The aim of this paper is to contribute to understanding of legal models that aim to control sex work, and the policy implications of these, by discussing the experience of developing a grassroots legislation bill proposal by organised sex workers in Córdoba, Argentina. The term 'grassroots legislation' here refers to a legal response that derives from the active involvement of local social movements and thus incorporates the experiential knowledge and claims of these particular social groupings in the proposal. The experience described in this paper excludes approaches that render sex workers as passive victims or as deviant perpetrators; instead, it conceives of sex workers in terms of their political subjectivity and of political subjectivity in its capacity to speak, to decide, to act and to propose. This means challenging current patterns of knowledge/power that give superiority to 'expert knowledge' above and beyond the claims, experiences, knowledge and needs of sex workers themselves as meaningful sources for law making.

Frailty's Place in Ethics and Law: Some Thoughts on Equality and Autonomy and on Limits and Possibilities for Aging Citizens

Consideration of ethical and legal themes relating to frailty must engage with the concern that frailty is a pejorative concept that validates and reinforces the disadvantage and vulnerability of aging adults. In this chapter, we consider whether a greater focus on frailty may indeed be part of the solution to the disadvantages that aging adults face in achieving equality and maintaining their autonomy within systems that have used their frailty to deny them equality and autonomy. First, by examining equality both as an ethical norm and as a requirement for protections against discrimination, we raise questions about the grounds on which health providers and health systems can be required to give equal concern and respect to the needs of frail older persons. Second, we explore autonomy and identify the tension between meaningful self-determination and prevailing ethical and legal norms associated with informed choice. Third, we argue that a proper understanding of frailty is essential within both of these themes; it respects equality by enabling health providers and systems to identify and address the distinct care needs of aging adults and helps to align informed choice theory with appropriate processes for decision-making about those needs.

Data-driven human rights: using the electronic health record to promote human rights in jail

The electronic health record (EHR) is a commonplace innovation designed to promote efficiency, quality, and continuity of health services. In the New York City jail system, we implemented an EHR across 12 jails between 2008 and 2011. During the same time, our work increasingly focused on the importance of human rights as an essential element to the provision of medical and mental health care for our patients. Consequently, we made major modifications to the EHR to allow for better surveillance of vulnerable populations and enable reporting and analysis of patterns of abuse, neglect, and other patient concerns related to human rights. These modifications have improved our ability to find and care for patients injured in jail and those with mental health exacerbations. More work is needed, however, to optimize the potential of the EHR as a tool to promote human rights among patients in jail.

Using human rights-based approaches to conceptualise lesbian and bisexual women's health inequalities

This article makes a contribution to current debates in human rights-based approaches to lesbian and bisexual (LB) women's health. With reference to concepts embodied in the Yogyakarta Principles, it is proposed that the right to health includes access to health information, participation, equity, equality and non-discrimination. Specifically, the article examines how LB women's health can be considered as a health inequality and discusses international developments to reduce disparities. Drawing on qualitative data collected in an online survey, the article reports on sexual minority women's experiences of health-care. Participants were recruited via a purposive sampling strategy; questionnaires were completed by 6490 respondents of whom 5909 met the study criteria of residence in the UK, sexual orientation and completing the survey once. Analysis revealed four broad themes: heteronormativity in health-care; improving attitudes among healthcare professionals; equality in access; raising awareness and informed communities. The accounts highlight the centrality of human rights principles: fairness, respect, equality, dignity and autonomy. The implications for healthcare policy and practice are discussed including ways to empower staff and service users with knowledge and skills and ensuring non-discrimination in health service delivery.

Health and human rights concerns of drug users in detention in Guangxi Province, China

BACKGROUND

Although confinement in drug detoxification ("detox") and re-education through labor (RTL) centers is the most common form of treatment for drug dependence in China, little has been published about the experience of drug users in such settings. We conducted an assessment of the impact of detention on drug users' access to HIV prevention and treatment services and consequent threats to fundamental human rights protections.

METHODS AND FINDINGS

Chinese government HIV and anti-narcotics legislation and policy documents were reviewed, and in-depth and key informant interviews were conducted with 19 injection drug users (IDUs) and 20 government and nongovernmental organization officials in Nanning and Baise, Guangxi Province. Significant contradictions were found in HIV and antinarcotics policies, exemplified by the simultaneous expansion of community-based methadone maintenance therapy and the increasing number of drug users detained in detox and RTL center facilities. IDU study participants reported, on average, having used drugs for 14 y (range 8-23 y) and had been confined to detox four times (range one to eight times) and to RTL centers once (range zero to three times). IDUs expressed an intense fear of being recognized by the police and being detained, regardless of current drug use. Key informants and IDUs reported that routine HIV testing, without consent and without disclosure of the result, was the standard policy of detox and RTL center facilities, and that HIV-infected detainees were not routinely provided medical or drug dependency treatment, including antiretroviral therapy. IDUs received little or no information or means of HIV prevention, but reported numerous risk behaviors for HIV transmission while detained.

CONCLUSIONS

Legal and policy review, and interviews with recently detained IDUs and key informants in Guangxi Province, China, found evidence of anti-narcotics policies and practices that appear to violate human rights and imperil drug users' health.

Contentious issues in research on trafficked women working in the sex industry: study design, ethics, and methodology

The trafficking of women and children for work in the globalized sex industry is a global social problem. Quality data is needed to provide a basis for legislation, policy, and programs, but first, numerous research design, ethical, and methodological problems must be addressed. Research design issues in studying women trafficked for sex work (WTSW) include how to (a) develop coalitions to fund and support research, (b) maintain a critical stance on prostitution, and therefore WTSW (c) use multiple paradigms and methods to accurately reflect WTSW's reality, (d) present the purpose of the study, and (e) protect respondents' identities. Ethical issues include (a) complications with informed consent procedures, (b) problematic access to WTSW (c) loss of WTSW to follow-up, (d) inability to intervene in illegal acts or human rights violations, and (e) the need to maintain trustworthiness as researchers. Methodological issues include (a) constructing representative samples, (b) managing media interest, and (c) handling incriminating materials about law enforcement and immigration.

Advocating for the rights of the mentally ill: a global issue

The media has shared with the American public horrors of abuse towards prisoners of war in recent newscasts. Prisoners, and others in vulnerable positions, can fall victim to neglect and abuse at the hands of their captors. Often, human rights can be violated. Therefore, people in vulnerable positions need advocates who will defend and protect their rights. The role of advocate is familiar to nursing professionals. In the mid-1980's advocacy grew attention due to disclosure of human rights abuses in mental health facilities. Today, worldwide, nursing leaders continue to confront abuses in multiple settings. In the United States, the Human Rights Authority was specifically developed to address issues of abuse of persons with physical disabilities and or mental illness. Globally, nurses will want to support the development and enforcement of policies that protect persons in vulnerable positions.

[Respecting rights of hospitalized children]

Children's rights are nowadays an important social, pedagogic, legal and moral problem. Practical respecting of resolutions included in the Convention on the Rights of the Child is far from perfect and requires changing social way of thinking. To attain this, the contents and essence of children's rights have to be disseminated and consequently enforced. The aim of my research was to answer the question: "What are the conditions for upholding children's right to respect at children wards?". The subject of my analysis was nurses' value hierarchy and individual conditions influencing respecting children rights. Research procedures were directed towards finding the answer to the following question: "What is the range of upholding children's right to respect?". I defined children's right to respect on the basis of analysis of Janusz Korczak's scientific output and the provisions of the Convention on the Rights of the Child. The rights being the subject of my research are classified either as "soft" or "hard" rights. "Soft" rights are defined in articles no. 12-16 and 31. Rights defined in articles no. 6, 7, 9 and 24 are referred to as "hard" rights. The synthesis of research results leads to the following solution of the research problem: The assumption of a strong influence of the most important values on mental life-thinking, perception, emotional-motivation processes, attitude and behavior of questioned nurses did not have proper empirical confirmation. Nurses' value hierarchy does not ensure upholding of children's right to respect in hospitals. Nurses' awareness of children rights reaches average level, while their knowledge and activity are at low level, and understanding of essence of children's rights and valuation of the rights--at average level. Average level of awareness of respecting children's rights makes children's existence in hospital imperiled by intuitive, often routine activities of nurses. The level of nurses' awareness is differentiated by age, place of employment and seniority. The dependence of awareness level upon questioned nurses' education has not been proved. The scale of upholding of children's right to respect has been defined on the basis of assumed indices conditioning the respect at an average level. It does not prove that children rights are respected in hospitals, as some of the rights are respected only to a small extent, causing menace to children existence. To change the existing situation, regular assessment of respecting children rights by all medical personnel shall be conducted regularly. Legal issues shall be included in the list of obligatory subjects of nursing studies and of all external forms of additional nurse training. These and other activities shall ensure existential safety for children in the hospital and increase the prestige of a nurse as a job.

Development of a questionnaire for quantitative assessment in the field of health and human rights

We hypothesize that a human rights framework would be able to analyse central health-related societal issues within important settings like the work place, the family or the health care system. Our study goal was the development and population-based evaluation of a questionnaire for assessment of the perceived human rights status. A questionnaire (HR-14) was developed from the guiding principles of international human rights legislation. For its psychometric evaluation, computer-assisted telephone interviews were conducted in four cities in Europe (Munich, Dresden, Vienna and Bern). Cronbach's alpha for internal consistency was 0.76. Factor analysis supported the concept of human rights as indivisible and interdependent. Extracted factors were consistent with the preliminary settings of family and friends, health care system and community at large, and a supplementary setting workplace. Perceived human rights status was associated with physical function, mental/emotional health, age, study region, general health and employment status. We conclude that it is possible to develop a human rights questionnaire with good psychometric properties. Measurement of the perceived human rights status of populations and population groups may contribute to health policies sensitive to human rights.

A population-based assessment of human rights abuses committed against ethnic Albanian refugees from Kosovo

OBJECTIVES

This study assessed patterns of displacement and human rights abuses among Kosovar refugees in Macedonia and Albania.

METHODS

Between April 19 and May 3, 1999, 1180 ethnic Albanian refugees living in 31 refugee camps and collective centers in Macedonia and Albania were interviewed.

RESULTS

The majority (68%) of participants reported that their families were directly expelled from their homes by Serb forces. Overall, 50% of participants saw Serb police or soldiers burning the houses of others, 16% saw Serb police or soldiers burn their own home, and 14% witnessed Serb police or soldiers killing someone. Large percentages of participants saw destroyed mosques, schools, or medical facilities. Thirty-one percent of respondents reported human rights abuses committed against their household members, including beatings, killings, torture, forced separation and disappearances, gunshot wounds, and sexual assault.

CONCLUSIONS

The present findings confirm that Serb forces engaged in a systematic and brutal campaign to forcibly expel the ethnic Albanian population of Kosovo. In the course of these mass deportations, Serb forces committed widespread abuses of human rights against ethnic Albanians.

Papers show U.S. role in Guatemalan abuses. In declassified documents, diplomats describe massacres, CIA ties to Army

Recently declassified U.S. intelligence documents reveal the close ties between the United States and the Guatemalan military and security forces during Guatemala's 36-year civil war, even though U.S. officials were aware of the government's and army's massive human rights abuses.

Children in the streets of Brazil: drug use, crime, violence, and HIV risks

The presence of vast numbers of unsupervised and unprotected children is a phenomenon that is common throughout Latin America, and in few places are the street children more visible, and reviled, than in Brazil. Estimates of their numbers in Brazil have ranged from 7 to 17 million, but more informed assessments suggest that between 7 and 8 million children, ages 5 to 18, live and/or work on the streets of urban Brazil. Accounts of drug misuse among street youths in Brazil are commonplace. Numerous scientific studies and media stories have reported the widespread use of inhalants, marijuana and cocaine, and Valium among street children. Also common is the use of coca paste and Rohypnol. Risk of exposure to HIV is rapidly becoming an area of concern because of the large number of street youths engaging in unprotected sexual acts, both renumerated and nonrenumerated. Moreover, Brazil's street children are targets of fear. Because of their drug use, predatory crimes, and general unacceptability on urban thoroughfares, they are frequently the targets of local vigilante groups, drug gangs, and police "death squads." Although there have been many proposals and programs for addressing the problems of Brazilian street youth, it would appear that only minimal headway has been achieved.

Ethical issues in healthcare reform: the experts and the public compared

Those of us in the healthcare industry have done a good job in demonstrating the value of our services in relationship to other activities government might undertake. We have done less well in recognizing the demands of individuals to make decisions about their own lives and the healthcare benefits they want. We continue to believe we know best, even to the point that we distrust the public to make appropriate decisions on their own behalf. A major part of freedom is the opportunity to learn from mistakes. When professionals restrict our freedom to choose, we all lose important rights. As the various bills make their way through Congress, we should look beyond our healthcare blinders and see that the public will reject industry-driven plans with almost the same level of suspicion given to the government and business.

Prevention of torture and care of survivors. An integrated approach

An analysis of the 1992 Amnesty International report demonstrates the nature and global distribution of reports of human rights violations. Systematic torture was reported in 93 of 204 countries. Reports of torture were more common from regions affected by political unrest, including mass demonstrations, riots, outbreaks of violence, killings, coup attempts, civil war, armed tribal conflict, rebellions, and conflicts with various opposition groups demanding social and political reform. These observations suggest that effective measures against torture require a multilevel analysis of underlying social, political, cultural, and psychological factors. Effective care of survivors of organized violence and torture is an indispensable component of the human rights struggle and needs more scientific attention. An integrated approach involving both preventive efforts and care of survivors can promote the human rights cause.

The role of physicians in conflicts and humanitarian crises. Case studies from the field missions of Physicians for Human Rights, 1988 to 1993

Violations of human rights in wars, civil conflicts, and brutal repression mounted by governments against their own citizens often have profound consequences to individual and public health and may, in turn, produce humanitarian crises. The skills of physicians, medical and forensic scientists, and other health workers are uniquely valuable in human rights investigations and documentation, producing evidence of abuse more credible and less vulnerable to challenge than traditional methods of case reporting. Only in recent decades, however, have physicians organized specifically to meet this responsibility. This article presents case studies from the field missions of Physicians for Human Rights to illustrate the investigation and documentation of violations of medical neutrality, refugee health crises, the use of indiscriminate weapons, torture, deliberate injury and rape, and mass executions. Participation of health workers in the defense of human rights now includes investigation and documentation of health effects in threatened populations as well as individual victims.

Rape as a crime of war. A medical perspective

Although widespread, rape of women has been an underreported aspect of military conflict until recently. The current war in the former Yugoslavia has focused attention on the use of rape as a deliberate strategy to undermine community bonds and weaken resistance to aggression. In addition to providing treatment for individual survivors, the medical community has an important role to play in investigating and documenting incidents of rape. Such documentation can help to establish the magnitude of rape in war and hold perpetrators accountable. Since rape in war affects not only the individual but also the family and community to which the survivor belongs, the restoration of social and community bonds is central to the process of healing and must be addressed within the specific cultural setting.