Frequent Undetected Ward-Based Methicillin-Resistant Staphylococcus aureus Transmission Linked to Patient Sharing Between Hospitals.

Background: Recent evidence suggests that hospital transmission of methicillin-resistant Staphylococcus aureus (MRSA) is uncommon in UK centers that have implemented sustained infection control programs. We investigated whether a healthcare-network analysis could shed light on transmission paths currently sustaining MRSA levels in UK hospitals. Methods: A cross-sectional observational study was performed in 2 National Health Service hospital groups and a general district hospital in Southeast London. All MRSA patients identified at inpatient, outpatient, and community settings between 1 November 2011 and 29 February 2012 were included. We identified genetically defined MRSA transmission clusters in individual hospitals and across the healthcare network, and examined genetic differentiation of sequence type (ST) 22 MRSA isolates within and between hospitals and inpatient or outpatient and community settings, as informed by average and median pairwise single-nucleotide polymorphisms (SNPs) and SNP-based proportions of nearly identical isolates. Results: Two hundred forty-eight of 610 (40.7%) MRSA patients were linked in 90 transmission clusters, of which 27 spanned multiple hospitals. Analysis of a large 32 patient ST22-MRSA cluster showed that 26 of 32 patients (81.3%) had multiple contacts with one another during ward stays at any hospital. No residential, outpatient, or significant community healthcare contacts were identified. Genetic differentiation between ST22 MRSA inpatient isolates from different hospitals was less than between inpatient isolates from the same hospitals (P ≤ .01). Conclusions: There is evidence of frequent ward-based transmission of MRSA brought about by frequent patient admissions to multiple hospitals. Limiting in-ward transmission requires sharing of MRSA status data between hospitals.

Human rights violations against sex workers: burden and effect on HIV.

We reviewed evidence from more than 800 studies and reports on the burden and HIV implications of human rights violations against sex workers. Published research documents widespread abuses of human rights perpetrated by both state and non-state actors. Such violations directly and indirectly increase HIV susceptibility, and undermine effective HIV-prevention and intervention efforts. Violations include homicide; physical and sexual violence, from law enforcement, clients, and intimate partners; unlawful arrest and detention; discrimination in accessing health services; and forced HIV testing. Abuses occur across all policy regimes, although most profoundly where sex work is criminalised through punitive law. Protection of sex workers is essential to respect, protect, and meet their human rights, and to improve their health and wellbeing. Research findings affirm the value of rights-based HIV responses for sex workers, and underscore the obligation of states to uphold the rights of this marginalised population.

The Global Commission on HIV and the Law: recommendations for legal reform to promote sexual and reproductive health and rights.

The Global Commission on HIV and the Law was established in 2010 to identify and analyse the complex framework of international, national, religious and customary law shaping national responses to HIV and the well-being of people living with HIV and key populations. Two years of deliberation, based on an exhaustive review of international public health and human rights scholarship, as well as almost 700 testimonials from individuals and organizations in more than 130 countries, informed the Commission's recommendations on reform to laws and practices that criminalize those living with and vulnerable to HIV, sustain or mitigate violence and discrimination lived by women, facilitate or impede access to HIV-related treatment, and/or pertain to children and young people in the context of HIV. This paper presents the Commission's findings and recommendations as they relate to sexual and reproductive health and rights, and examines how the Commission's work intersects with strategic litigation on forced sterilization of women living with HIV, legal reform on the status of transgender individuals, initiatives to improve police treatment of female sex workers, and equal property rights for women living with HIV in sub-Saharan Africa and Latin America.

Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern.

Community action is broadly recognised as central to comprehensive and effective system responses to pandemics. However, there is uncertainty about how and where communities can be best supported to bolster long-term resilience and preparedness. We applied a typology of community interventions (Community Informing, Consulting, Involving, Collaborating or Empowering-or CICICE) to cover the diverse range of interventions identified across the literature and used this to structure a scoping review addressing three linked topics: (i) how CICICE interventions have been understood and applied in the literature on epidemic and pandemic preparedness; (ii) the spectrum of interventions that have been implemented to strengthen CICICE and (iii) what evidence is available on their effectiveness in influencing preparedness for current and future emergencies. We drew on peer-reviewed and grey literature from the HIV (from 2000) and COVID-19 pandemics and recent public health emergencies of international concern (from 2008), identified through systematic searches in MEDLINE, Scopus, the Cochrane Collaboration database, supplemented by keyword-structured searches in GoogleScholar and websites of relevant global health organisations. Following screening and extraction, key themes were identified using a combined inductive/deductive approach. 130 papers met the criteria for inclusion. Interventions for preparedness were identified across the spectrum of CICICE. Most work on COVID-19 focused on informing and consulting rather than capacity building and empowerment. The literature on HIV was more likely to report interventions emphasising human rights perspectives and empowerment. There was little robust evidence on the role of CICICE interventions in building preparedness. Evidence of effect was most robust for multi-component interventions for HIV prevention and control. Much of the reporting focused on intermediate outcomes, including measures of health service utilisation. We put forward a series of recommendations to help address evidence shortfalls, including clarifying definitions, organising and stratifying interventions by several parameters and strengthening evaluation methods for CICICE.

Correction: Community interventions for pandemic preparedness: A scoping review of pandemic preparedness lessons from HIV, COVID-19, and other public health emergencies of international concern.

[This corrects the article DOI: 10.1371/journal.pgph.0002758.].

Human Rights and Digital Health Technologies.

Digital health technologies have been heralded as a critical solution to challenges and gaps in the delivery of quality health care and essential to achieving the Sustainable Development Goals. Yet they also present threats to privacy and confidentiality, which can lead to discrimination and violence, resulting in violations of the rights to health, housing, employment, freedom of assembly, expression, protection from arbitrary detention, bodily autonomy, and security. More broadly, without proper planning and safeguards, digital health technologies can contribute to expanding health inequity, widening the "digital divide" that separates those who can and cannot access such interventions. This article outlines key harms related to digital technologies for health, as well as ethical and human rights standards relevant to their use. It also presents several strategies for mitigating risks from digital health technologies and reviews mechanisms of accountability, including recent judicial rulings.

Rights and policy front and centre at the conference.

There were more sessions than ever on human rights and policy at this conference--86 abstracts, 46 poster discussions, 702 posters, and numerous crosscutting, bridging and satellite sessions. In this article, based on her summary of Track E (Policy and Politics) at the rapporteur session on the final day of the conference, Mandeep Dhaliwal presents a summary of key themes and messages that emerged from Track E.

The "AIDS and MDGs" approach: what is it, why does it matter, and how do we take it forward?

Progress towards the Millennium Development Goals (MDGs) has been mixed, and many observers have noted the tendency for development actors to address individual MDGs largely in isolation from one another. This in turn has resulted in missed opportunities to catalyse greater interdisciplinary collaboration and innovation towards MDG achievement. The term 'AIDS and MDGs' is gaining currency as an approach that aims to explore, strengthen and leverage the links between AIDS and other health and development issues. Drawing from academic literature and from MDG country reports, this article sets out three important pillars to an AIDS and MDGs approach: 1) understanding how AIDS and the other MDGs affect one another; 2) documenting and exchanging lessons learned across MDGs; and 3) creating cross- MDG synergy. We propose broader policy level implications for this approach and how UNDP and other partners can take this agenda forward. Because the MDGs explicitly locate HIV within a broader international commitment to human development targets, they provide a critical platform for development partners to galvanise resources, political will and momentum behind a broader, systematic and structural approach to HIV, health and development.

HIV risk among MSM in Senegal: a qualitative rapid assessment of the impact of enforcing laws that criminalize same sex practices.

Men who have sex with men (MSM) are at high risk for HIV in Senegal, with a prevalence of 21.5%. In December 2008, nine male HIV prevention workers were imprisoned for "acts against nature" prohibited by Senegalese law. This qualitative study assessed the impact of these arrests on HIV prevention efforts. A purposive sample of MSM in six regions of Senegal was recruited by network referral. 26 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) were conducted in July-August 2009. 14 key informants were also interviewed. All participants reported pervasive fear and hiding among MSM as a result of the December 2008 arrests and publicity. Service providers suspended HIV prevention work with MSM out of fear for their own safety. Those who continued to provide services noticed a sharp decline in MSM participation. An effective response to the HIV epidemic in Senegal should include active work to decrease enforcement of this law.