Rigged or rigorous? Partnerships for research and evaluation of complex social problems: Lessons from the field of violence against women and girls.

There is growing demand for robust evidence to address complex social phenomena such as violence against women and girls (VAWG). Research partnerships between scientists and non-governmental or international organizations (NGO/IO) are increasingly popular, but can pose challenges, including concerns about potential conflicts of interest. Drawing on our experience collaborating on VAWG research, we describe challenges and contributions that NGO/IO and academic partners can make at different stages of the research process and the effects that collaborations can have on scientific inquiry. Partners may struggle with differing priorities and misunderstandings about roles, limitations, and intentions. Benefits of partnerships include a shared vision of study goals, differing and complementary expertise, mutual respect, and a history of constructive collaboration. Our experience suggests that when investigating multi-faceted social problems, instead of 'rigging' study results, research collaborations can strengthen scientific rigor and offer the greatest potential for impact in the communities we seek to serve.

Health care providers and human trafficking: what do they know, what do they need to know? Findings from the middle East, the Caribbean, and central america.

BACKGROUND: Human trafficking is a crime that commonly results in acute and chronic physical and psychological harm. To foster more informed health sector responses to human trafficking, training sessions for health care providers were developed and pilot-tested in the Middle East, Central America, and the Caribbean. This study presents the results of an investigation into what health care providers knew and needed to know about human trafficking as part of that training program. METHODS: Participants attended one of seven two-day training courses in Antigua and Barbuda, Belize, Costa Rica, Egypt, El Salvador, Guyana, and Jordan. We assessed participants' knowledge about human trafficking and opinions about appropriate responses in trafficking cases via questionnaires pre-training, and considered participant feedback about the training post-training. RESULTS: 178 participants attended the trainings. Pre-training questionnaires were completed by 165 participants (93%) and post-training questionnaires by 156 participants (88%). Pre-training knowledge about health and human trafficking appeared generally high for topics such as the international nature of trafficking and the likelihood of poor mental health outcomes among survivors. However, many participants had misconceptions about the characteristics of trafficked persons and a provider's role in responding to cases of trafficking. The most valued training components included the "Role of the Health Provider," "Basic Definitions and Concepts," and "Health Consequences of Trafficking." DISCUSSION: Training health care providers on caring for trafficked persons has the potential to improve practitioners' knowledge about human trafficking and its health consequences, and to increase safe practices when responding in cases of trafficking. This study provides lessons for the design of training programs on human trafficking that aim to help health care providers identify and refer victims, and provide care for survivors.

Health of men, women, and children in post-trafficking services in Cambodia, Thailand, and Vietnam: an observational cross-sectional study.

BACKGROUND: Trafficking is a crime of global proportions involving extreme forms of exploitation and abuse. Yet little research has been done of the health risks and morbidity patterns for men, women, and children trafficked for various forms of forced labour. METHODS: We carried out face-to-face interviews with a consecutive sample of individuals entering 15 post-trafficking services in Cambodia, Thailand, and Vietnam. We asked participants about living and working conditions, experience of violence, and health outcomes. We measured symptoms of anxiety and depression with the Hopkins Symptoms Checklist and post-traumatic stress disorder with the Harvard Trauma Questionnaire, and used adjusted logistic regression models to estimate the effect of trafficking on these mental health outcomes, controlling for age, sector of exploitation, and time in trafficking. FINDINGS: We interviewed 1102 people, of whom 1015 reached work destinations. Participants worked in various sectors including sex work (329 [32%]), fishing (275 [27%]), and factories (136 [13%]). 481 (48%) of 1015 experienced physical violence, sexual violence, or both, with 198 (35%) of 566 women and girls reporting sexual violence. 478 (47%) of 1015 participants were threatened and 198 (20%) were locked in a room. 685 (70%) of 985 who had data available worked 7 days per week and 296 (30%) of 989 worked at least 11 hours per day. 222 (22%) of 983 had a serious injury at work. 61·2% (95% CI 58·2-64·2) of participants reported symptom of depression, 42·8% (39·8-45·9) reported symptoms of anxiety, and 38·9% (36·0-42·0) reported symptoms of post-traumatic stress disorder. 5·2% (4·0-6·8) had attempted suicide in the past month. Participants who experienced extremely excessive overtime at work, restricted freedom, bad living conditions, threats, or severe violence were more likely to report symptoms of depression, anxiety, and post-traumatic stress disorder. INTERPRETATION: This is the first health study of a large and diverse sample of men, women, and child survivors of trafficking for various forms of exploitation. Violence and unsafe working conditions were common and psychological morbidity was associated with severity of abuse. Survivors of trafficking need access to health care, especially mental health care. FUNDING: Anesvad Foundation and International Organization for Migration International Development Fund.

The dynamics of health and return migration.

The increasing importance and complexity of migration globally also implies a global increase in return migration, and thus an increased interest in the health of returning migrants. The health of returning migrants is impacted by the cumulative exposure to social determinants and risk factors of health during the migration process, during the return movement, and following return. Circular migration often occurs among the diaspora, which can result in the transfer of knowledge and skills that contribute to development, including health system strengthening. Migrants with dual nationality often return to countries with better health services than their country of origin when they are sick and can not get care at home. To maintain and improve the health of returning migrants, multi-sectoral policies at global and national levels should facilitate access to appropriate and equitable health services, social services, and continuity of care across and within borders.

Southern Africa ports as spaces of HIV vulnerability: case studies from South Africa and Namibia.

There is increasing recognition that in order to respond to the HIV epidemic migrants and mobile populations must be included in national and regional responses. While migration in and of itself does not necessarily contribute to increased risk of HIV infection, some migrants and mobile populations do face increased HIV risk. With its immense coastline and extensive transport industry, Southern Africa provides an excellent case study to examine the HIV risks and vulnerabilities of mobile workers and local communities through port settings. IOM's research in Southern African ports illustrates why HIV/AIDS policies and programmes must focus on spaces where migrants and mobile populations interact with sedentary populations (including sex workers and other sexual partners) in environments conducive to multiple concurrent partnerships, in order to reduce HIV risk and increase access to treatment, care, and support for all.

Differential mortality patterns between Nicaraguan immigrants and native-born residents of Costa Rica.

BACKGROUND: This study describes the all-cause and cause-specific mortality of Nicaraguan-born and native-born inhabitants of Costa Rica and examines the influence of socioeconomic and demographic factors on differential mortality risks. METHODS: We analyzed Costa Rican vital records for the years 1996-2005 with negative binomial regression models to determine the relative mortality risks of Nicaraguan immigrants versus Costa Rican natives with adjustments for age, urbanization, unemployment, poverty, education, and residential segregation. RESULTS: Nicaraguan-born men and women had reduced mortality risks of 32% and 34% relative to their Costa Rican-born counterparts. Excess homicide mortality was found among Nicaraguan-born men [rate ratio (RR) = 1.35, 95% CI: 1.19-1.53] and women (RR = 1.41, 95% CI: 1.02-1.95). DISCUSSION: The Nicaraguan-born population had a reduced all-cause mortality risk versus Costa Rican-born people over the years 1996-2005, due to markedly lower disease mortality. Homicide is a major source of excess mortality among Nicaraguan-born immigrants versus Costa Rican natives.