Transactional sex in humanitarian settings: A comparative analysis of livelihood and demographic predictors.

Millions of people have been displaced within or outside their countries. Disruptions associated with displacement often lead to transactional sex with dire social, sexual and reproductive health implications. A common driver of transactional sex is food insecurity among refugees and internally displaced persons (IDPs), yet IDP/refugee settings offer an opportunity for females to challenge and renegotiate gender norms and exercise greater control over their lives and sexuality. We compared predictors of transactional sex across humanitarian settings and found them to be significantly different. Among IDPs, the likelihood of transactional sex reduces with having access to food ration and education, but increases with having 'other sources' of income. Among refugees, transactional sex likelihood reduces with having either/both parent(s) alive but increases with working for money. Hence, multiple factors drive transactional sex in different contexts. Protecting women in humanitarian situations from the risks of transactional sex requires an understanding of these differences.

Des millions de personnes ont été déplacées à l'intérieur ou à l'extérieur de leur pays. Les perturbations associées au déplacement conduisent souvent à des relations sexuelles transactionnelles avec des conséquences désastreuses sur la santé sociale, sexuelle et reproductive. L'insécurité alimentaire parmi les réfugiés et les personnes déplacées à l'intérieur de leur propre pays (PDI) est un facteur courant du sexe transactionnel. Pourtant, les contextes de PDI/réfugiés offrent aux femmes la possibilité de remettre en question et de renégocier les normes de genre et d'exercer un plus grand contrôle sur leur vie et leur sexualité. Nous avons comparé les prédicteurs du sexe transactionnel dans différents contextes humanitaires et nous avons constaté qu'ils étaient significativement différents. Parmi les personnes déplacées, la probabilité de relations sexuelles transactionnelles diminue avec l'accès à la ration alimentaire et à l'éducation, mais augmente avec « d'autres sources ¼ de revenus. Parmi les réfugiés, la probabilité de relations sexuelles transactionnelles diminue lorsque l'un ou les deux parents sont en vie, mais augmente lorsque l'on travaille pour de l'argent. Par conséquent, de multiples facteurs déterminent le sexe transactionnel dans différents contextes. Protéger les femmes dans les situations humanitaires contre les risques liés aux relations sexuelles transactionnelles nécessite une compréhension de ces différences..

The relationship of the source of punishment and personality traits with investment and punishment in a public goods game.

In this study, we investigated the motivations behind punishing individuals who exploit common resources, a phenomenon crucial for resource preservation. While some researchers suggest punishment stems from concern for the common good, others propose it is driven by anger toward free riders. To probe these motivations, we developed a modified public goods game in which participants had the option to use their own money or the money from the common pool to punish free riders. The analysis included choice behavior, mouse trajectories, and personality traits like anger, empathy, and altruism. According to our results, investments were highest, and punishment was strongest if participants could punish using credits from the common pool, indicating that this is the preferred option to diminish free riding and maintain cooperation in public goods and common good contexts. Also, punishment was highest if the punisher's own investment was high, and the investment of others was low. Concerning traits, highly altruistic individuals tended to invest more and punish less in general but gave harsher punishments when they did choose to use the common pool punitively. Conversely, trait anger and trait empathy were linked to low investment while trait empathy also tended to be related to lower punishment. Taken together, these findings underscore the role of situational factors and personality traits in fostering cooperative behavior and shaping societal norms around costly punishment.

Findings of an evaluation of a sexual and reproductive health programme in a humanitarian setting for the forcibly displaced Myanmar nationals in Cox's Bazar, Bangladesh.

Background: Since August 2017, around 940 000 forcibly displaced Myanmar nationals (FDMN), mostly women and children, have fled persecution in Myanmar and arrived in the refugee camps across the border in Cox's Bazar, Bangladesh. This large-scale humanitarian crisis created an urgency for sexual and reproductive healthcare-related services among many of the sexually assaulted FDMN women and girls. Ipas, an international non-governmental organisation (NGO) that has been working on expanding access to safe menstrual regulation, post-abortion care, and family planning services in Bangladesh since 2011, initiated an emergency humanitarian response programme in the refugee camps in Cox's Bazar in 2017 for the victim FDMN women and girls who were in desperate need of care. To understand the implementation process and the scope of sustainability and scale-up of Ipas's programme in the current humanitarian settings, icddr,b, a Bangladesh-based international health research institution, conducted an evaluation study. Methods: Due to the emergency crisis situation, Ipas could not collect baseline data while initiating its humanitarian response programme in 2017. Only a post-evaluation was carried out by icddr,b from August to December 2022 based on a desk review, health facility observation and assessment, qualitative interviews, and a stakeholder consultation workshop. Results: In collaboration with relevant stakeholders from the Government of Bangladesh and local and international NGOs, Ipas performed structural renovation and logistical arrangements to ensure facility readiness within the camps. Until December 2022, it provided comprehensive training on menstrual regulation, post-abortion care, and family planning services to around 700 service providers from partner organisations and expanded its activities from 8 to 51 service delivery points in 23 camps. Overall, 42 213 FDMN women received menstrual regulation and post-abortion care, while 339 334 received family planning services from these facilities, with a growing trend over time. Conclusions: Despite the challenges and barriers inherent to a humanitarian setting, Ipas's programme activities have achieved significant progress in providing menstrual regulation, post-abortion care, family planning services, and trauma/survival-centred care to the FDMN women and girls. A flexible approach, stakeholder coordination and commitment, cohesive methods for health systems strengthening, and community engagement were instrumental to the success of Ipas's humanitarian response programme.

Implementing a pragmatic randomised controlled trial in a humanitarian setting: lessons learned from the TISA trial.

INTRODUCTION: High-quality evidence is crucial for guiding effective humanitarian responses, yet conducting rigorous research, particularly randomised controlled trials, in humanitarian crises remains challenging. The TISA ("traitement intégré de la sous-nutrition aiguë") trial aimed to evaluate the impact of a Water, Sanitation and Hygiene (WASH) intervention on the standard national treatment of uncomplicated Severe Acute Malnutrition (SAM) in children aged 6-59 months. Implemented in two northern Senegalese regions from December 22, 2021, to February 20, 2023, the trial faced numerous challenges, which this paper explores along with the lessons learned. METHODS: The study utilised trial documentation, including field reports, meeting minutes, training plans, operational monitoring data and funding proposals, to retrace the trial timeline, identify challenges and outline implemented solutions. Contributions from all TISA key staff-current and former, field-based and headquarters-were essential for collecting and interpreting information. Challenges were categorised as internal (within the TISA consortium) or external (broader contextual issues). RESULTS: The TISA trial, executed by a consortium of academic, operational, and community stakeholders, enrolled over 2000 children with uncomplicated SAM across 86 treatment posts in a 28,000 km2 area. The control group received standard outpatient SAM care, while the intervention group also received a WASH kit and hygiene promotion. Initially planned to start in April 2019 for 12 months, the trial faced a 30-month delay and was extended to 27 months due to challenges like the COVID-19 pandemic, national strikes, health system integration issues and weather-related disruptions. Internal challenges included logistics, staffing, data management, funding and aligning diverse stakeholder priorities. DISCUSSION AND CONCLUSION: Despite these obstacles, the trial concluded successfully, underscoring the importance of tailored monitoring, open communication, transparency and community involvement. Producing high-quality evidence in humanitarian contexts demands extensive preparation and strong coordination among local and international researchers, practitioners, communities, decision-makers and funders from the study's inception. TRIAL REGISTRATION: Clinicaltrials.gov NCT04667767 .

An Evidence Gap Map of Experience-based Evidence of Health Resource Allocation in Disaster and Humanitarian Settings.

OBJECTIVE: The aim of this review is to identify, evaluate, and graphically display gaps in the literature related to scarce health resource allocation in humanitarian aid settings. METHODS: A systematic search strategy was utilized in MEDLINE (via Ovid), Scopus, EMBASE, CINAHL Complete, and ProQuest Central. Articles were reviewed by 2 reviewers with a third reviewer remedying any screening conflicts. Articles meeting inclusion criteria underwent data extraction to facilitate evaluation of the scope, nature, and quality of experience-based evidence for health resource allocation in humanitarian settings. Finally, articles were mapped on a matrix to display evidence graphically. RESULTS: The search strategy identified 6093 individual sources, leaving 4000 for screening after removal of duplicates. Following full-text screening, 12 sources were included. Mapping extracted data according to surge capacity domains demonstrated that all 4 domains were reflected most of all the staff domain. Much of the identified data was presented without adhering to a clear structure or nomenclature. Finally, the mapping suggested potential incompleteness of surge capacity constructs in humanitarian response settings. CONCLUSIONS: Through this review, we identified a gap in evidence available to address challenges associated with scarce resource allocation in humanitarian settings. In addition to presenting the distribution of existing literature, the review demonstrated the relevance of surge capacity and resource allocation principles underpinning the developed framework.

Exploring the link between empathy, stress, altruism, and loneliness in university students during the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: Empathy has been associated with a range of positive outcomes, including social connection, pro-social behavior, and mental health. Nonetheless, acknowledging the multidimensional aspects of empathy, budding research indicates that sometimes empathy may precipitate negative health outcomes. AIM: In the present paper, we explore the extent to which the multidimensional aspects of empathy-as measured by the Interpersonal Reactivity Index-may relate to the experience of increased stress during the COVID-19 pandemic. We also examine potential behavioral moderators (altruism) and social mediators (loneliness) of any such effect. METHOD: We conducted a cross-sectional survey study of 2595 Danish university students and implemented linear regression analyses to determine the relationships between our key variables. RESULTS: In both crude and adjusted regression models, our findings indicate positive associations between the IRI subscales Fantasy, Empathic Concern, and Personal Distress on self-reported stress and loneliness. Perspective Taking was marginally and inversely associated with stress but not loneliness. Altruism did not moderate these associations, but loneliness did mediate the effects of Fantasy, Empathic Concern, and Personal Distress on stress. DISCUSSION: Our results emphasize the importance of conceptualizing empathy in multi-dimensional terms. Further, our study highlights the potential negative health consequences of empathy in certain settings. These results may help focus future research in this area and feed into mental health interventions.

Justifying access to kidney care in low resource and humanitarian settings.

PURPOSE OF REVIEW: Access to and quality of kidney care is not equitable between or within countries. A natural question is whether global kidney care inequities are always unjustifiable and unfair, or are sometimes due to unavoidable competing or conflicting ethical duties or responsibilities. RECENT FINDINGS: Health is a fundamental right for all people. People with kidney conditions should have the same claim on this human right as others. Countries have an obligation to progressively fulfil this right and a duty to do so equitably, but global progress has been slow. Countries with limited resources or faced with humanitarian emergencies must set priorities to allocate resources fairly. This process involves trade-offs and often people requiring kidney replacement therapy are left out because of costs, logistics and lack of data. Major burdens are placed on clinicians who grapple between their duty to their patient and professional codes and their responsibility to a 'greater good'. These dilemmas apply also to industry, governments and the international community who must recognize their share in these duties. SUMMARY: Inequities in kidney health and care must be acknowledged and sustainable and collaborative solutions urgently found such that right to kidney care is progressively upheld for everyone everywhere.

The motive cocktail in altruistic behaviors.

Prosocial motives such as social equality and efficiency are key to altruistic behaviors. However, predicting the range of altruistic behaviors in varying contexts and individuals proves challenging if we limit ourselves to one or two motives. Here we demonstrate the numerous, interdependent motives in altruistic behaviors and the possibility to disentangle them through behavioral experimental data and computational modeling. In one laboratory experiment (N = 157) and one preregistered online replication (N = 1,258), across 100 different situations, we found that both third-party punishment and third-party helping behaviors (that is, an unaffected individual punishes the transgressor or helps the victim) aligned best with a model of seven socioeconomic motives, referred to as a motive cocktail. For instance, the inequality discounting motives imply that individuals, when confronted with costly interventions, behave as if the inequality between others barely exists. The motive cocktail model also provides a unified explanation for the differences in intervention willingness between second parties (victims) and third parties, and between punishment and helping.

Third-party punishment-like behavior in a rat model.

Third-party punishment (TPP) is an altruistic behavior or sense willing to punish transgressors as a third party not directly involved in the transgression. TPP is observed worldwide, regardless of tradition and culture, and is essential for morality in human society. Moreover, even preverbal infants display TPP-like judgement, suggesting that TPP is evolutionarily conserved and innate. Thus, it is possible that non-human animals display TPP-like behavior, although TPP has been said to be human-specific. We investigated whether or not male mature Wistar rats displayed TPP-like behaviors when they witnessed deadly aggression by an unknown aggressive mouse toward another unknown victim mouse. Normally reared rats did not display TPP-like behaviors, but rats reared with extensive affectionate handling by human caretakers as beloved pets contacted the unknown aggressive mice in a gentle manner leading to reduced aggression toward the unknown victim mice, even when the aggressive mice fought back. Furthermore, the handled rats touched unknown rat pups that were drowning in water and anesthesia-induced comatose rats more frequently than control rats. These findings suggest a possibility that TPP is not in fact human-specific and innate but rather an acquired behavior that flourishes in affectionate circumstances.

GPT-3.5 altruistic advice is sensitive to reciprocal concerns but not to strategic risk.

Pre-trained large language models (LLMs) have garnered significant attention for their ability to generate human-like textand responses across various domains. This study delves into examines the social and strategic behavior of the commonly used LLM GPT-3.5 by investigating its suggestions in well-established behavioral economics paradigms. Specifically, we focus on socialpreferences, including altruism, reciprocity, and fairness, in the context of two classic economic games: the Dictator Game(DG) and the Ultimatum Game (UG). Our research aims to answer three overarching questions: (1) To what extent do GPT-3.5suggestions reflect human social preferences? (2) How do socio-demographic features of the advisee and (3) technicalparameters of the model influence the suggestions of GPT-3.5? We present detailed empirical evidence from extensiveexperiments with GPT-3.5, analyzing its responses to various game scenarios while manipulating the demographics of theadvisee and the model temperature. Our findings reveal that, in the DG Dictator Game, model suggestions are more altruistic than in humans.We further show that it also picks up on more subtle aspects of human social preferences: fairness and reciprocity. Thisresearch contributes to the ongoing exploration of AI-driven systems' alignment with human behavior and social norms,providing valuable insights into the behavior of pre-trained LLMs and their implications for human-AI interactions.Additionally, our study offers a methodological benchmark for future research examining human-like characteristics andbehaviors in language models.

The "New-Old" Dimensions of Caring in Humanitarian Response: The Opportunity for Public Health Palliative Care to Advance the Humanitarian-Development Nexus, Decoloniality, and Localization Thought.

How can palliative care framings advance humanitarian discourse? The imperative for palliative care in humanitarian settings is increasingly urgent. Recent efforts by health and humanitarian organizations demonstrate increasing attention to the issue. Yet palliative care is still not adequately formally considered or enacted by humanitarian agencies in rhetoric, policy, research, or practice. Even where it is considered in humanitarian action, palliative care is often assumed to be a novel intervention, rather than a caring practice that has existed from time immemorial, including in humanitarian situations. The generation of ideas in this paper has followed a dynamic, iterative, and reflexive process through engagement with key literature, critical thinking, conversations with colleagues across both sectors, primary data, and debate amongst the authors. The paper argues that the current dominant frame of a new, specialized, professionalized, and medicalized palliative care in the humanitarian sector would perpetuate existing challenges. It contends that viewing both fields through a "new-old" lens, where historical and traditional caring practices intertwine with progressive discourse for a more just and appropriate public health response, can further humanitarianism. It posits that the humanitarian-development nexus, decoloniality, and localization thought can benefit from palliative care practice through critical interaction with a broad range of literature.

Is in-kind kinder than cash? The impact of money vs. food aid on social emotions and aid take-up.

Over the past decade, there has been a shift in the way charities deliver humanitarian aid. Historically, the most prevalent way to help the global poor was by providing in-kind asset transfers. Recently, alternatives to in-kind aid, such as cash aid, have been increasing in prevalence. Although there has been widespread endorsement from the academic community and the public on the popularizing model of giving cash aid, one perspective remains untouched: the recipient's perspective. Thus, the present research explores how food-insecure individuals feel when receiving money vs. in-kind food aid to help meet their hunger and nutrition needs. Specifically, we explore the degree of positive (e.g., feeling cared for) and negative (e.g., feeling ashamed) social emotions felt when receiving the aid opportunity and how willing recipients are to accept monetary (vs. food) aid. Results from five preregistered experiments (N = 3,110)-a field experiment in Kenya and four online experiments in the United States-find that monetary (vs. food) aid elicits comparatively more of a market-pricing relationship and less of a communal sharing relationship and, hence, makes people feel less positive and more negative social emotions when receiving the help. Subsequently, recipients are less likely to take up monetary (vs. food) aid from a charity. However, we find that this effect does not persist when receiving government aid: Recipients are similarly willing to accept money and in-kind food aid from the government. This research suggests that future scholarship ought to examine ways to improve psychological experiences when receiving money from charity.

Altruism and natural selection in a variable environment.

Hamilton's rule provides the cornerstone for our understanding of the evolution of all forms of social behavior, from altruism to spite, across all organisms, from viruses to humans. In contrast to the standard prediction from Hamilton's rule, recent studies have suggested that altruistic helping can be favored even if it does not benefit relatives, as long as it decreases the environmentally induced variance of their reproductive success ("altruistic bet-hedging"). However, previous predictions both rely on an approximation and focus on variance-reducing helping behaviors. We derived a version of Hamilton's rule that fully captures environmental variability. This shows that decreasing (or increasing) the variance in the absolute reproductive success of relatives does not have a consistent effect-it can either favor or disfavor the evolution of helping. We then empirically quantified the effect of helping on the variance in reproductive success across 15 species of cooperatively breeding birds. We found that a) helping did not consistently decrease the variance of reproductive success and often increased it, and b) the mean benefits of helping across environments consistently outweighed other variability components of reproductive success. Altogether, our theoretical and empirical results suggest that the effects of helping on the variability components of reproductive success have not played a consistent or strong role in favoring helping.

Inequality as determinant of donation: A theoretical modeling and empirical analysis of Korea.

Recipient financial need is a crucial factor in donation decisions. This study proposes a novel model for determining financial donations, incorporating consumption levels of both donor and recipient within a societal context. Solving our model's utility maximization problem reveals how consumption, donation, and savings are interlinked. Empirical evidence reinforces these findings, aligning with prior research and showing that larger consumption gaps between donors and recipients lead to increased donations. Our findings point towards an inherent altruistic motivation in donation, where elevating the recipient's well-being ultimately enhances the donor's own utility. This reinforces the notion that consideration of the recipient's financial hardship, as reflected by their consumption patterns, is crucial when making donation decisions. Shifting beyond traditional models, this study introduces a groundbreaking approach to financial donations. Our novel model factors in consumption levels of both the donor and recipient, along with the broader societal context, using utility maximization to unravel the intertwined decisions of consumption, donation, and savings. Real-world data validates our model, confirming known donation factors and revealing a key finding: larger disparities in consumption lead to increased giving, suggesting an altruistic drive where helping others boosts personal satisfaction.

Lessons from the COVID-19 pandemic to strengthen NCD care and policy in humanitarian settings: a mixed methods study exploring humanitarian actors' experiences.

BACKGROUND: The COVID-19 pandemic and response severely impacted people living with non-communicable diseases (PLWNCDs) globally. It exacerbated pre-existing health inequalities, severely disrupted access to care, and worsened clinical outcomes for PLWNCDs, who were at higher risk of morbidity and mortality from the virus. The pandemic's effects were likely magnified in humanitarian settings, where there were pre-existing gaps in continuity of care for non-communicable diseases (NCDs). We sought to explore factors affecting implementation of NCD care in crisis settings during the COVID-19 pandemic and the adaptations made to support implementation. METHODS: Guided by the Consolidated Framework for Implementation Research, we undertook an online survey of 98 humanitarian actors from multiple regions and organization types (March-July 2021), followed by in-depth interviews with 13 purposively selected survey respondents (October-December 2021). Survey data were analysed using descriptive statistics, while interview data were analysed thematically, using both deductive and inductive approaches. RESULTS: Initially, humanitarian actors faced challenges influenced by external actors' priorities, such as de-prioritisation of NCD care by governments, travel restrictions and supply chain interruptions. With each infection wave and lockdown, humanitarian actors were better able to adapt and maintain NCD services. The availability of COVID-19 vaccines was a positive turning point, especially for the risk management of people with NCDs and protection of health workers. Key findings include that, despite pre-existing challenges, humanitarian actors largely continued NCD services during the crisis. Enabling factors that supported continuity of NCD services included the ability to quickly pivot to remote means of communication with PLWNCDs, flexibility in medicine dispensing, and successful advocacy to prioritize NCD management within health systems. Key lessons learned included the importance of partnerships and cooperation with other health actors, and the mobilisation or repurposing of community health workers/volunteer networks. CONCLUSIONS: The COVID-19 experience should prompt national and global health stakeholders to strengthen inclusion of NCDs in emergency preparedness, response, and resilience planning. Key lessons were learned around remote care provision, including adapting to NCD severity, integrating community health workers, providing context-adapted patient information, combating misinformation, and strengthening cross-sectoral partnerships.

Prosocial sharing with organizations after the COVID-19 pandemic: A longitudinal test of the role of motives for helping and time perspectives.

The time after the COVID-19 pandemic posed a threat to engagement in prosocial behaviors within charity organizations. In the current study, we intended to test how three motivational paths: affective empathy-based, life satisfaction-based, and perceived social support-based shaped the change in intentions to give money and time to charity organizations over a yearly period (right after revocation of the most essential anti-COVID-19 laws and at the same time, outbreak of the war in Ukraine in 2022, in May 2022 and after a year, in late April-early May 2023). We also tested how past negative and present hedonistic time perspectives-namely, those most robust in predicting emotional states - shaped the changes in the abovementioned motivational paths and giving intentions. We conducted our longitudinal study on the general population of Poland (N = 566). We found that there has been a significant drop in the willingness to give time to organizations over the year after loosening the COVID-19 restrictions and the outbreak of war in Ukraine. We found that affective empathy helped sustain the intentions to give time to organizations, whereas past negative time perspective contributed to the decrease in such intentions. Our study suggests threats to organizations and highlights potential ways to encourage supporting them and caring for their volunteers' well-being.