#socio-demographic

[jcrmhscasereports]

Prevalence of Hepatitis b and c viral infections among human immunodeficiency virus (HIV) infected patients on highly active anti-retroviral therapy (haart) in the university of port harcourt teaching hospital By Abel Charles In Journal of Clinical Case Reports Medical Images and Health Sciences 

ABSTRACT

Introduction: This study determined the prevalence of hepatitis B and C viral infections among human immunodeficiency virus (HIV) infected patients on highly active anti-retroviral therapy (HAART) in the University of Port Harcourt Teaching Hospital.

Methodology: It was a purposive, cross-sectional study that was conducted in the Anti-retroviral clinic of the facility and a sample size of 38.33 (increased to 100, due to perceived small size), using a prevalence of 2.56% from a previous study by Nnakenyi et al. (2019).

Results: There was more female participation, 77.0%, majority had secondary school education, 59.0%, mostly Civil servants, 43.0%, Christians, 87.0% and mainly of Ijaw ethnicity, 39.0%. Majority had heard of HBV and HCV, 84.0%, mainly in the hospital, 36.9%, with the least from friends/family members, 6.0%, 98.0% had not been infected by any of the hepatic viruses, all of them affirmed that the viruses can be treated, 100.0%, while 72.0% confirmed the efficacy of medical treatment for the viruses and 46.0% had been vaccinated against the viruses. Also, majority opined that sexual intercourse is the main route for transmission of the hepatic viruses, 51.0%, followed by blood transfusion, 37.0% and lifestyle is the most common risk factor to contract the viruses, 71.0%. The prevalence of HBV, HCV and VDRL among HIV-infected patients on HAART was 96.0%, 98.0% and 99.0% respectively. Similarly, we observed statistical significance of HBV (0.042) and HCV (0.021), as well as, venereal diseases (0.028).

Conclusion: There is low prevalence of the hepatic viruses among HIV infected persons in the study population, while the existence of a venereal disease is a risk factor to contracting the hepatic viruses, owing to similar pathways of transmission, thus, rigorous efforts at educating the populace about the risk factors and common routes of transmission of these viruses is required.

Keywords: Hepatitis, venereal disease, HIV, HAART, infection.

INTRODUCTION

Human immunodeficiency virus (HIV) is a retrovirus that infects humans and other mammals. Infection by the virus is a huge public health problem, with African being one of the most affected by the pandemic globally resulting in an estimated 25.7 million human infections worldwide (World Health Organization [WHO], 2019).

Viral hepatitis is also a global health challenge of public concern worldwide (Ndifontiayong, Ali, Sokoudjou, Ndimumeh & Tume, 2021). Some of the features associated with the micro-organisms are high prevalence, high mortality and morbidity, poor diagnostic tools, leading to sub-optimal diagnosis and poor management approaches, especially, in developing countries (Naghavi, Wang, Lozano, Davis, Liang, Zhou, Vollset, Ozgoren, Abdalla & Abd-Allah, 2015; Mokdad, Lopez, Shahraz, Lozano, Mokdad, Stanaway, Murray & Naghavi, 2014).

Hepatitis B virus (HBV) alters the liver architecture and may progress to chronic, life-threatening conditions, such as liver cirrhosis and hepatocellular carcinoma or otherwise mild case, known as hepatitis (Nnakenyi, Uchehukwu & Nto-ezimah, 2020). The global prevalence of HBV is estimated as 0.1%-20% (McMahon, 2005; Custer, Sullivan, Hazlet, Lloeje, Veenstra & Kowdley, 2004) and its diagnosis is made by detection from blood and body fluids, such as semen, saliva and nasopharyngeal secretion, while the main routes of transmission are sexual intercourse, mother to child transmission in pregnancy, delivery and breastfeeding, blood contact and sharing of infected materials (WHO, 2011).

In 2017, the World Health Organization (WHO) reported that the global prevalence of hepatitis B surface antigen (HBsAg) in the African region was 60 million, with an estimated prevalence of 6.1% (4.6% - 8.5%) and accounting for an estimated 87,890 annual deaths in sub-Saharan African region alone. Both HIV and HBV infections pose a reciprocal effect on the progression of both diseases in regards to the impact on the morbidity and mortality of the diseases, with co-infection being a serious challenge in resource-constrained settings (Xie, Han, Qiu, Li, Li, Song, Wang, Thio & Li, 2016; Milazzo & Antinori, 2014). In the western countries, complications arising from HBV and HCV and the infections itself are rare, but common in Asia and Africa, where the chronic infection is common and usually acquired through the parenteral route or in adulthood (Lavanchy, 2004).

Hepatitis C virus (HCV) is also a major cause of hepatitis, like HBV, with a chronic potential (Nnakenyi et al., 2020). The transmission of HCV is similar to HBV. There are scanty prevalence data for HCV, especially, in sub-Saharan African region, but approximately 30 million people are reported to be infected by the virus (Matthews, Geretti, Goulder & Klenerman, 2014). HCV also leads to chronic liver diseases like hepatocellular carcinoma, (Ndifontiayong et al., 2021). Both HBV and HCV are very prevalent in patients infected by HIV and those with the disease condition of HIV, AIDS, leading to an increased morbidity and mortality (Spearman, Afihene, Ally, Apica, Awuku & Cunha, 2017). The co-infection of HIV with either HBV, HCV is associated with poor survival, rapid progression to liver diseases and high potential for hepatotoxicity, arising from the anti-retroviral therapy administered (WHO, 2013; Highleyman, 2010).

Globally, an estimated 550 million people are infected by either HBV or HCV, about 9% of the world population, with the former estimated as 350-400 million, while the latter is estimated as 170-180 million (WHO, 2013; Lavanchy, 2011). Also, the three viruses; HIV, HBV and HCV dominant infections in sub-Saharan African, with 2.6 million HBV infections in HIV-infected people and approximately 2.3 million HCV in HIV-infected people (Kourtis, Bulterys, Hu & Jamieson, 2012).

Highly active anti-retroviral therapy, HAART, is a current, commonly implemented regimen for managing HIV infection. It is an innovation in HIV management and effectively reduces the viral load, as well as, increases the CD4 cell count.

Human Immunodeficiency Virus (HIV) infection, in itself, poses enormous burden on the health care system of many countries. However, the condition of infected individuals is worsened in the existence of co-infection, such as the hepatitis virus, causing poor prognosis and potentially shortens life span (Nnakenyi et al., 2020). It rapidly depletes the immune function of the host, as well as, other vital systems of the affected individual. Evidence suggests that HIV infection progresses faster, even to AIDS-defining illnesses, when there is a co-infection with hepatitis viruses (Greub, Ledergerber, Battegay, Grob, Perrin & Furrer, 2000).

Owing to this co-infection, it is advised that when treating HIV patients, their status of HBV and HCV is ascertained, if the patient is actually co-infected by any of the hepatitis viruses. This is important because a report by the WHO global hepatitis strategy for the elimination of viral hepatitis stipulates that by the year 2030, hepatitis disease will assume a huge public health propensity, thus, 80% of individuals eligible for HBV or HCV treatment should be availed the treatment (WHO, 2016). Despite this, in most developing countries, such as Nigeria, the screening for the hepatitis viruses is still a challenge, due to the cost of investigation or vaccination, unlike in HIV (Diwe, Okwara, Enwere, Azike & Nwaimo, 2013).

Prevalence studies abound in Nigeria regarding co-infection of HIV with either hepatitis B or C viruses, employing different settings and population sizes (Hamza et al., 2013; Idoko, Meloni, Muazu, Nimzing, Badung & Hawkins, 2009; Otegbayo, Taiwo, Akingbola, Odaibo, Adedapo & Penugonda, 2008; Ejele, Nwauche & Erhabor, 2004), with diverse but similar results.

In Nigeria, the national guideline for the prevention, treatment and care for HIV-infected patients does not recommend the screening for HBV, but hepatitis B surface antigen, HBsAg, and HCV commonly done as baseline test for the pre-treatment of HIV-infected patients (National Guidelines for HIV Prevention, Treatment and Care, 2016).

In a study conducted in Enugu state, Nigeria, among 1328 HIV-infected patients on HAART, Nnakenyi et al. (2020) reported that the prevalence of hepatitis B virus infection was 7.8%. Another study conducted among 1779 HIV-infected patients in a different geo-political region in Nigeria, reported HBV prevalence of 11.9% (Otegbayo et al., 2008), while other independent, but similar studies employing smaller sample sizes compared to the those earlier described, ranged from 9.7% to 25.0% (Idoko et al., 2009; Uneke, Ogbu, Inyama, Anyanwu, Njoku & Idoko, 2005; Ejele, Nwauche & Erhabor, 2004).

Regarding the co-infection of HIV and HCV, several studies documented distinct findings, majority of which suggest population size and diagnostic equipment and technique plays crucial roles in the prevalence. In some studies conducted in Nigeria, by Nnekanyi et al. (2020), Diwe et al. (2013) and Adewole, Anteyi, Ajuwon, Wada, Elegba and Ahmed (2013), prevalence values of 4.7%, 0.7% and 2.3% respectively were reported respectively.

Similarly, Nnekanyi et al. (2020) and Adewole et al. (2013) reported that HBV is more prevalent and the situation may be similar for other studies both within and outside Nigeria. Observations show that the varying sample sizes of the populations in the respective studies accounted for the differences reported in their prevalence, while positing that although, the three viruses are transmitted through similar routes, their rates of transmission could be dissimilar. For instance, HIV transmission, historically, is most common through the parenteral route, such as multiple blood transfusions and intravenous drug use, in addition to sexual transmission, but the sexual transmission route is less common for HCV (Tedaldi, Hullsiek, Malvestutto, Arduino, Fisher & Gaglio, 2003).

Yet another finding on the co-infection between HIV and either HBV or HCV also reported gender bias against the transmission, especially, HBV. The study reported that HIV/HBV co-infection is more common among men that have sex with men, as against men that have sex with women or women that have sex with women, the transmission being almost inefficient in the latter category, while it is also commoner in heterosexual individuals with multiple sexual partners and contacts with commercial sex workers (Alter, 2006).

Triple infection of the three viruses; HIV, HBV and HCV have been observed in certain circumstances. In three individual groups of study conducted in the southeast, north-central and a sub-urban part of Nigeria by Nnakenyi et al. (2020), Adewole et al. (2009) and Diwe et al. (2013), they reported the prevalence of triple infection as 0.58%, 1.5% and 0% respectively. In response to the varying findings in the respective studies, Nnakenyi and colleagues posited that at this point, it will be difficult to discern if residing in the city poses more risk to contracting triple infection and whether social lifestyle in the urban regions is implicated in the observed prevalence, which is absent in the sub-urban region.

Opaleye, Oluremi, Ogbolu, Babalola, Shittu and Adesiyan (2014) also investigate the prevalence of HBV among HIV-infected patients HAART regimen and reported more male co-infection, while the age group of 30-49 years were more predominantly co-infected.

In a study in Burkina Faso among 11,592 blood donors, with sero-positive HIV blood, 1.13% prevalence of HBV co-morbidity with HIV was reported, while the prevalence of HCV among the HIV sero-positive patients was 0.14% (Tounkara, Sarro, Kristensen, Dao, Diallo & Diarra, 2009). This is a clear contrast from the studies documented from the different geo-political regions in Nigeria and may differ from what is tenable in other climes. A review of comparative studies on the prevalence of HBV among HIV-infected patients in four continents; Asia, Africa, America and Europe, reported higher prevalence of co-infection among patients in the developed continents of America and Europe, as against those in the developing continents of Africa and Asia (Askari, Hakimi, Nasiri, Hassanshahi & Kazemi, 2014). The higher prevalence in the patients of developed continents was attributed to better diagnostic equipment and lower sensitivities available in these continents, as against the developing continents.

The treatment of co-infection with HIV and any of HBV or HCV is another area of interest that have elicited several research discourses. At the moment, HAART is the mainstay for individuals with HIV infection and the combination of HAART regimen for the different co-infection varies. This regimen, HAART, comprises of five main drugs that include; tenofovir, Ribavirin, sofosbuvir and emtricitabine. Studies have reported that in cases of HIV/HBV co-infection, tenofovir and emtricitabine should be employed, since these drugs are effective for the two viruses and reduces the likelihood of HBV developing resistance for any of the drugs, while in co-infection of HIV/HCV, ribavirin and sofosbuvir should be used, just as HBV vaccine can be administered in situations of HIV/HBV co-infection (National Guidelines for Human Immunodeficiency Virus Prevention, Treatment and Care, 2016).

While several studies have been conducted both within and outside Nigeria to ascertain the prevalence of HBV or HCV co-infection among HIV patients on HAART, there is scanty data regarding this in the study area, thus necessitating this study, hoping that it will not only serve as reference, but also avail clinicians and scientists the required information for prompt decisions when attending to these category of patients.

METHODOLOGY

This purposive, cross-sectional study was conducted at the Anti-retroviral clinic and Pathology laboratory of the University of Port Harcourt Teaching Hospital (UPTH), Nigeria, a tertiary healthcare facility located in the southern region of the country and caters for the training of medical students and other allied medical professions, medical and epidemiologic research, as well as, treatment and counseling of medical conditions. A minimum sample size of 38.33 was obtained for the study, using a prevalence of 2.56% (being the average for 4.7%, 0.7% and 2.3% reported for HIV, HBV and HCV respectively) as reported by Nnekanyi et al. (2020), Diwe et al. (2013) and Adewole et al.  (2013). However, owing to the small nature of the calculated minimum sample size, it was increased to 100, to make it significant.

5ml venous blood sample was obtained from each participant in the study using an ethylene diamine tetra acetic acid (EDTA) bottle, after they consented to participate and this analyzed by the aid of an auto-analyzer and the result entered into statistical package for social sciences (SPSS) version 22, where both descriptive and inferential analysis were performed. The socio-demographic parameters of the respondents were obtained using a structured questionnaire and also analyzed. Ethical approval for this study was obtained from the Research Ethics Committee of the University of Port Harcourt Teaching Hospital.

RESULTS

This study had more females, 77.0%, they mostly had secondary school education, 59.0%, with the least having primary school education, 18.0%, and were mostly civil servants, 43.0%, while 27.0% were traders and 17.0% were schooling. Also, majority, 87.0% were Christians, but 6.0% were Muslims and they were mostly Ijaws by ethnicity, 39.0%, followed by Igbos, 35.0%, while the least were Hausas, 4.0%.

In table 2 above, it was observed that most of the respondents have heard about the HBV and HCV, 84.0%, with most of them hearing about it in the hospital, 36.9%, followed by school, 32.1%, while the least heard from friends/family members, 6.0%. However, 98.0% had not been infected by any of the hepatic viruses, with all of them affirming that the viruses can be treated, 100.0%, while 68.0% responded that it can affect anybody, while only 1.0% mentioned it can affect children. Similarly, 72.0% of the respondents agreed that the viruses can be treated medically, but 1.0% person mentioned its treatment by fasting/prayer, with less than half, 46.0% taken vaccination against the viruses and those that have not been vaccinated was mostly due to the cost, 88.9%, while the least was due to attitude of health personnel, 1.9%.

The factors that influence the transmission of hepatitis B and C viruses, according to the respondents in this study, is presented in table 3 above. It shows majority of them responding to sex, 51.0%, followed by blood transfusion or blood products, 37.0%, while lifestyle is the most reported risk factor for contracting the viruses, 71.0%, followed by smoking, 13.0%, and the least being canned foods, 1.0%.

DISCUSSIONS

This study recorded more female participation, 77.0%, majority had secondary school education, 59.0%, mostly Civil servants, 43.0%, mostly Christians, 87.0% and mostly Ijaw by ethnic inclination, 39.0%. The finding about more female participation in this study is not surprising, due to the known fact that the female reproductive tract is more receptive and bound to be more impact in infections contracted through sexual intercourse, such as HIV, HBV and HCV. Apart from this, females tend to be more pursuant to seek healthcare than their male counterparts, except the health condition has truly impacted the males, before they reluctantly seek health care. This is in confirmation by the WHO (2019) that women tend to seek help more for their health needs, as well as, being more infected with venereal diseases that are usually, long-standing, owing to the long duration associated with it before clinical symptoms begin to manifest, sometimes, years.

This study also observed that majority of the respondents have heard of HBV and HCV, 84.0%, with many hearing of it in the hospital, 36.9% and the least heard from friends/family members, 6.0%. HIV, like HBV (usually commonly known as hepatitis), are widespread disease conditions, especially, the former, and majority of the populace are aware of it, due to the fact the fact that information about them are ubiquitous. The findings of HIV and HBV in this study are in tandem with those of Ndifontiayong et al. (2021) and Naghavi et al. (2015) respectively. It was also observed in this study that 98.0% of the respondents had not been infected by any of the hepatic viruses, with all of them affirming that the viruses can be treated, 100.0%, with only 1.0% indicating infection in children, while 72.0% confirmed the efficacy of medical treatment for the viruses and 46.0% had been vaccinated against the viruses. This agrees with the report by Highleyman (2010) that although HBV and HCV are in existence and widespread, their prevalence is considerably low in the general population (McMahon, 2005).

We also observed that shows majority of our study participants responded to sexual intercourse being the main route for transmission of the hepatic viruses, 51.0%, followed by blood transfusion or blood products, 37.0% and lifestyle is the most common risk factor for contracting the viruses, 71.0%.  The findings of this study disagrees with that of Liaw et al. (2010), which reported that the parenteral route is the most dominant route of transmission of HBV, HCV and HIV globally, especially, through mother to child transmission during delivery and breastfeeding, while other routes, like sexual intercourse, are also common. The prevalence of HBV, HCV and VDRL among HIV-infected patients on HAART in this study was 96.0%, 98.0% and 99.0%. This is an attestation of the finding by McMahon (2005) that the global prevalence of the hepatic viruses was low in the general population. Similarly, we observed statistical significance of HBV (0.042) and HCV (0.021) venereal diseases, such as HIV. This, we believe to be a common trend, since they mostly share common routes of transmission. However, it confirms the reports by Xie et al. (2016), Milazzo and Antinori (2014), and Lavanchy (2004).

CONCLUSIONS

There seems to be low prevalence of the hepatic viruses, even among HIV infected persons in the general population, while the existence of a venereal disease may encourage or serve as risk factor for contracting the hepatic viruses, since they share similar routes of transmission. This, calls for more concerted efforts at educating the populace about the risk factors and common routes of transmission of these viruses.

Conflict of Interest

None.

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

[shilohta]

Regretfully concluding that "Peter from July Talk is trans" is actually not true, and was just something that I dreamed up.

[ot3]

If you don't know this already, please try and internalize it: the idea that people join the US military primarily because they are young people at a disadvantage in life coerced into believing it is the most accessible path to upward mobility is not true.

if you're parroting this talking point, you are doing propaganda for the US military and you just need to stop saying it. here's an article from the Military Times that breaks the finding of various studies like this one from 2020 and this one from 2018 that analyze motivations for joining the military and popular conceptions of motivations for joining the military. Here's a pretty important excerpt:

Further, they hypothesized that some of this possible misconception about poorer Americans joining the military was a geographical issue. While the Defense Department tracks the zip codes of recruits ― and historically, many of them come from more rural areas in the southeast ― it doesn’t track their incomes or their parents’ incomes, which leads to assumptions that the poorer their communities, the poorer the recruits. [...] Using Bureau of Labor Statistics data from 1997 to 2008, they found that the services have recruited primarily from the middle class, America’s largest socio-economic demographic. “We show that recent recruits tend to have higher than average socioeconomic background: they disproportionally come from the middle of the family income, family wealth, and cognitive skill distributions, with both tails under-represented,” they found.

Here's from the army times:

Surveyed troops said these were the top five reasons for staying in the Army. The percentages indicate how many troops felt the factors were “extremely important” to them:

- Opportunity to serve my country — 53.5% - How well my retirement pay or benefits will meet my future needs — 45.1% - Opportunities to lead or train soldiers — 43.5% - My sense of purpose — 38.1% -How well my pay or benefits meet my present needs — 37%

Also mentioned in other sources but here from the NY times in 2020 as well, army enlistment is becoming increasingly skewed towards being the children of people who have previously served.

The main predictors are not based on class or race. Army data show service spread mostly evenly through middle-class and “downscale” groups. Youth unemployment turns out not to be the prime factor.

'Joining the army to lift yourself out of poverty' is not the reality for military service, it is the narrative used by the military in it's marketing and recruitment. if you go around repeating it i hope for your sake you're at least on their payroll! if you're going to bootlick don't do it for free!

[m1ssc0mmun1cat10n]

Supermarkets really be insulting my intelligence, putting a 'low price!' sticker next to a truly outrageous number. Oh, only $6 for a bag of crisps? What kind of a fool do you think I am?

[rqbossman]

Why do you know brainrot terms? It's scares me

Because the generational divide is an artificial cultural construct used primarily to distract people from Socio-Economic inequality and gatekeeping generational slang that is not tied to a specific sub-demographic only serves to reinforce the distraction. Or to put it another way: Sigmas Eat Werther's Originals whilst listening to Linken park and playing Roblox, no cap.

[anyab]

Via NasAlSudan

Learn about the Sudanese revolution, the significance of December 19, and a legacy of resistance and resilience.

Join our call to action today and everyday during Sudan Action Week.

December 19 2023

Transcript:

Breaking it down

What is the Sudanese Revolution?

The Sudanese Revolution refers to the popular uprising in Sudan that began on December 19, 2018 and eventually deposed 30-year dictator of Sudan, Omar al-Bashir, on April 11 of 2019.

How did the Revolution begin?

Protests first began in Atbara, a city with historical significance to the labor movement in Sudan, in response to the rising costs of basic supplies such as bread and fuel.

Protestors set fire to the national party headquarters, and the news of their revolt quickly spread, inspiring protestors first in other cities, and then in the capital of Khartoum itself.

Online, the caption #TasgutBas, translating to #JustFall, grew in popularity and helped connect the diaspora to those in Sudan.

Was it really just bread?

No. The rising cost of bread in developing nations is an indicator of how badly the economy is strained, to the point where it impacts members of every social class.

At this point in time in Sudan, subsidies on essential goods had been rolled back, funding for social and state services such as healthcare and education was nearly nonexistent, and it is estimated that nearly 90% of economic activity took place in the informal sector, all while the military budget continually increased.

Transcript:

Who led the charge? Creating a revolution

Group: Sudanese Professional's association (SPA)

Who they are:

Group of labor and trade organizations formed in secret in 2012 and publicly declared in 2016

Backbone of grassroots organizing in Sudan

Role played:

Led action on the street, organized national protests, like the initial march on Khartoum for increased wages before the transition to calls for regime change, and worker strikes.

Group: Local Resistance Committees (LRCS)

Who they are:

Initially formed as groups of students and youth organized together on the more local, neighbourhood basis during the Bashir era

Membership is extremely diverse across socio-economic, ethnic, tribal, religious, and political lines

Role played:

Considered the lifeblood of the revolution, with youth organizing local protests and ensuring safety against governmental repression by standing on the front lines + providing security, food, water, and medication to people

Group: Forces for freedom and change (FFC)

Who they are:

Coalition comprising the SPA, LRCS, the Sudan Revolutionary Front (group of anti-governmental Darfur militias), political parties, and civil society groups

Role played:

Essentially became the political mouthpiece of the revolution and signed onto the transitional government with the military on behalf of Sudanese civilians

It is also crucial to note that from a demographic perspective, it is youth and women that largely led and comprised the Sudanese Revolution.

Trabscript:

How did the revolution succeed?

01. Learning from the Past

Following the Arab Spring wave, Sudan also attempted a revolution in September of 2013

Civilians faced violent crackdowns within the first three days of protest. 200 killed, 800+ arrested

Activists were deterred from mobilization + felt a lot of guilt at the massive loss of life and spent the next 5 years grounding themselves in the study of nonviolent theory and action

02. Building a Movement

Coalition Building and People Power

Diversification of the reach of the movement to make sure all sectors of Sudani society were represented

Decentralization of Activism

Past revolutions in 1964 and 1985 were concentrated in the labor movement and educational elites in Khartoum

This time, experienced nonviolent activists trained those in the capital and ensured ethnic, religious, and tribal diversity

Newly trained activists then taught others locally across the Sudanese states

Transcript:

Why december 19?

On December 19, 1955, the Sudanese parliament unanimously adopted a declaration of independence from the Anglo-Egyptian colonial power.

The declaration went into effect on January 1, 1956, which is why Independence Day is officially January 1, but December 19 is when the Sudanese people were truly liberated from colonial rule.

The flag shown is Sudan's independence flag. The blue is for the Nile, the yellow for the Sahara, and the green for the farmlands.

The current Sudanese flag was adopted in 1970, with the colors used being the Pan-Arab ones.

During the 2019 revolution, protestors often carried the independence flag instead as a form of resistance to the narrative of an exclusive Pan-Arab Sudanese identity.

December 19 is ultimately a tribute to Sudanese strength and resilience. It honors our independence and revolutionary martyrs - not just those of the 2019 revolution, but the democratic revolutions of 1964 and 1985 as well.

Transcript:

Why is the revolution ongoing?

The goal was never just the fall of a dictator. The goal was, and is, to build a better Sudan, one free from military rule. One with equal opportunities for everyone, with economic prosperity and safety and security - the key principles of freedom, peace, and justice that the revolution called for.

Today, though, before we rebuild Sudan, before we free it from foreign interests and military rule and sectarianism, we need to save it. Each day that passes by with war waging on is one where more civilians are killed. More people are displaced. More women are raped. More children go hungry. To live in the conflict zones in Sudan right now - whether that be Khartoum, Darfur, Kordofan, or now, Al Gezira, is to be trapped in a never-ending nightmare, a fight for survival. And to live elsewhere in Sudan is to wonder whether you're next.

Sudan Action Week calls on you to educate yourself and others about Sudan, and then to help the Sudanese people save it, because we can no longer do it alone.

Transcript:

What can you do? Uniting for Al Gezira and North Darfur

As we witness the unfolding events in Al Gezira and North Darfur, the communities of Abu Haraz, Hantoub, Medani, El Fasher, and many others are reaching out for assistance. Sudanese resilience persists to this day, with individuals on platforms like Facebook, Twitter, Instagram, and TikTok seeking and providing guidance on transportation services, medical care, food, shelter, protection, safe zones, operational markets, and more. This isn't new for the Sudanese community. A legacy of unity emerged, notably during the 2019 revolutions, where nas al Sudan [the people of Sudan], both within the nation and in the diaspora, rallied together to support each other online. Beyond merely sharing stories on social media, this was about strengthening collective action, enhancing mobilizations, and building a resilient community rooted in solidarity. The essence of the Sudanese community lies in people supporting people, notably during the uprising in 2018 and following the events of April 15th, 2023

Swipe to see how you can help.

Transcript:

What can you do?

This week, on a day nearly mirroring Sudanese Independence and the popular 2018 uprising, Sudanese resilience endures as war follows nas al Sudan to Al Gezira and again in North Darfur. Our call to action this week is not just to share; it's a collective effort to uplift one another.

Share Resources:

If you have access to resources that can help such as transportation services, medical assistance, food, shelter, etc., please comment below.

Community Requests:

If you are in Al Gezira or North Darfur and require specific support, please comment on your needs

Connect Individuals:

For those unable to share resources directly, help amplify requests by sharing this information within your personal networks. Your connection may lead to support from individuals who can assist.

Spread the Word:

Share this call to action on your social media platforms to broaden the reach and encourage more people to contribute.

Transcript:

Hanabniho

حنبنيهوا

[We will rebuild]

#keepEyesOnSudan

#SudanActionWeek

[lets-steal-an-archive]

Under the six-week ban, providers could not perform abortions if they detected fetal cardiac activity, which emerges at about six weeks into pregnancy. Many women, McBurney wrote, do not even know they are pregnant at six weeks.

“For these women, the liberty of privacy means that they alone should choose whether they serve as human incubators for the five months leading up to viability,” McBurney wrote. “It is not for a legislator, a judge, or a commander from The Handmaid’s Tale to tell these women what to do with their bodies during this period when the fetus cannot survive outside the womb any more so than society could – or should – force them to serve as a human tissue bank or to give up a kidney for the benefit of another.”

In a footnote, McBurney added: “There is an uncomfortable and usually unspoken subtext of involuntary servitude swirling about this debate, symbolically illustrated by the composition of the legal teams in this case. It is generally men who promote and defend laws like the Life Act, the effect of which is to require only women – and, given the socio-economic and demographic evidence presented at trial, primarily poor women, which means in Georgia primarily black and brown women – to engage in compulsory labor, ie, the carrying of a pregnancy to term at the government’s behest.”

[hahahafangirl]

gotta put my thoughts down before i forget it but the thing that did it in for me is how spy x family is ultimately and uniquely a “children-focused” work, where the major stakes require that we pay attention to the lives and dynamics of young children so that — specifically — we have to genuinely engage with and invested in their inner lives, motivations, desires, thoughts, emotions, etc.

i think this is a very unique focus in the shounen sphere, where the audience and creators are centered about adolescent boys (the shounen genre, in its name) and thus have a very wide scope of focus that nonetheless has “aged” past “childhood”. usually media about children and childhood are sequestered in its own genre (children’s shows like doraemon, magical girl anime like precure series, etc.) aimed at a different target audience who are in the same demographic as the main characters in the shows. this is, obviously, not a bad thing. but i appreciate the “genre-breaking” focus that spy x family have because it inspires a sort of empathy to children, who are often not the most favorite group of people for the typical demographic of shounen readers, that is specifically vital in today’s climate. (can’t say much about japan itself, who historically has been dealing with declining birth rates, but oh i can speak for the american individualism— ironically where sxf is also very popular in) another thing about this is it’s drive home how intertwined the family life is, and should be. agent twilight and thorn princess’s plot-lines are clearly shounen-esque (a spy fighting for world peace, an assassin weeding out traitors) but they are nonetheless inextricable from the family- and anya-focused story, because by choice or circumstances they are anya’s parents. they’re a part of a larger societal fabric that embedded them in relationships to others — children being one of them. i think that’s pretty neat.

another thing, specially about the depiction of children in sxf: they are fictitious yet realistic enough to portray real children and inspire sympathy for them. a lot of asian home media in general have the problems of portraying young children as “problems”: annoying, loud, privileged, dumb, ungrateful, etc etc. these are such complaints about children that are unfortunately way too common and way too ungenerous and mean-spirited; none of these tropes are present, even in a media full of scions and heiress. complaints about them being brats (red circus bus hijacking arc) was rightfully framed as unsympathetic and unreasonable (they’re children! they can’t help where they were born into— it goes both ways.) i think the crux of this beautiful balance sxf struck in portraying nuanced, dynamics children is sympathy. they can be loud, they can be whiny, cry at the drop of a hat, has too much energy, gross, have bad grades, clingy, inconsistent, academically unmotivated, ran off randomly— and that’s fine, because we know why they do it, we are given space into their inner thoughts, something so rarely afforded to real life children at times. but they can be motivated, they want world peace, they want to have genuine friends, they want their friends to be happy, they have crushes, and most of all they love their parents and they love the people around them.

i think regardless of everything sxf is a work that understands that children are full of love and the majority of the things they do are out of love. i think that alone makes it incredible in the current socio-econo-political climate where sympathy is spared so little and humanity spreads so thin children barely gets what they deserve. i suppose that’s the sort of war we are entrenched in.

[whencyclopedia]

The Politics of Reproduction in Ottoman Society, 1838-1900

"The Politics of Reproduction in Ottoman Society, 1838-1900" sheds light on how turbulent population changes led to anxieties in the Ottoman elites and the state. In this context, Balsoy illustrates how medical modernization was employed by authorities to discipline the female body and control the population. The book provides a clear image of the 19th Century’s perspective on women in Ottoman society and is a must-read for those interested in Ottoman women's history.

Gülhan Balsoy is a professor of history at Istanbul Bilgi University. The book is a revised and rewritten version of Balsoy’s PhD thesis. The book's five chapters respectively focus on the history and transformation of midwifery, abortion, pregnancy, and infertility in Ottoman society. While investigating these themes, Balsoy asserts that reproduction was not a natural experience but a political subject. Balsoy examines how the Ottoman state and elites attempted to change together with control of the female body and subjected it to medical and legal control by using institutions, laws, and medical doctors. According to Balsoy, the state and Ottoman elites constructed the pronatalist means to increase the Turkish/Muslim population by transforming midwifery practices, banning abortion, medicalizing pregnancy/childbirth, and inclining on infertility issues. Balsoy challenges the dominant idea in the historical scholarship that the Ottomans attempted to create a heterogenous Ottoman identity in the society.

The main contribution of this book is derived from the reception of medical modernization through political and institutional means. It demonstrates that the medical elites or obstetricians reflected the Ottoman state’s mentality on the decline of the Turkish/Muslim population. For example, the first law on abortion in 1838, the establishment of the Midwifery School in 1842, and licensing midwives or prioritizing obstetricians were precautions for the state’s population anxiety. However, after investigating literature on Besim Ömer, a famous pronatalist, and Ottoman obstetrician at that time, Balsoy successfully showed that the dichotomy between “old crones” and doctors were not the whole picture. Besim Ömer and many obstetricians asserted that "old crones" were uneducated and lacked hygiene. Despite their ideas about untrained midwives, doctors or licensed midwives also experienced failures in their operations. Thus, the problem put forward by Besim Ömer was not demographic but political and ideological. Another impactful aspect of the book is how anti-abortion and pronatalist ideas are represented in popular literature and advice books for pregnant women. These sources help us to map a combination of social mentality and forced pronatalist agenda by Ottoman authorities, which controlled and disciplined female bodily experiences to alleviate the population anxieties of the elites.

Despite these contributions, there lacks an explanation of how and why these elites had population anxiety or whether they were sure about their homogeneous Ottoman identity in every case. In other words, did all Ottoman elites have this population anxiety? Many sources utilized by Balsoy usually only show us the perception of the Ottoman obstetricians. Another point raised is the comparison between other social groups. For example, the practices of non-Muslim women, especially midwifery or the medicalization process of pregnancy and their experiences, are lacking. However, including other socio-ethnic and religious groups may enrich the literature on the effects of reproduction policies. It is understandable that this book lacks in these two points since finding primary sources written by women and other disenfranchised groups in Ottoman society has always been a challenge for historical scholarship.

This book is an academically fulfilling work on the late Ottoman society. Specifically, prescriptive or advice books and popular literature are utilized quite well in this book. However, her main argument about the politicization of reproduction and the female body stays slightly rigid because the primary Ottoman sources give us a more sophisticated picture than Balsoy's main argument. The spread of pronatalist ideas and politicization of the female body via medicalization and legal means can provide a portrait of how the state and the elites may have population anxieties. Nevertheless, we still cannot avoid the complexities of social changes in the public area, especially when there are few personal or collective accounts of women. In the end, Balsoy's argument is well-researched and invaluable for opening up a space for discussing the female experiences in the late period of Ottoman society.

Continue reading...

[justinspoliticalcorner]

Carter Sherman at The Guardian:

A Georgia judge on Monday struck down the state’s six-week abortion ban, ruling that the ban is unconstitutional and blocking it from being enforced. In a 26-page opinion, the Fulton county superior judge Robert McBurney ruled that the state’s abortion laws must revert to what they were before the six-week ban – known as the Life Act – was passed in 2019. The ban was blocked as long as Roe v Wade was the law of the land, but went into effect after the US supreme court overturned Roe in 2022. “When a fetus growing inside a woman reaches viability, when society can assume care and responsibility for that separate life, then – and only then – may society intervene,” McBurney wrote. Abortions are now legal in Georgia up until about 22 weeks of pregnancy – the point at which Georgia permitted abortions prior to the Life Act. However, fetal viability tends to occur closer to 24 weeks of pregnancy. Although the Roe line of jurisprudence was supposed to prevent states from banning abortion prior to fetal viability, Georgia and several other states did so anyway even before Roe fell.

Under the six-week ban, providers could not perform abortions if they detected fetal cardiac activity, which emerges at about six weeks into pregnancy. Many women, McBurney wrote, do not even know they are pregnant at six weeks. “For these women, the liberty of privacy means that they alone should choose whether they serve as human incubators for the five months leading up to viability,” McBurney wrote. “It is not for a legislator, a judge, or a commander from The Handmaid’s Tale to tell these women what to do with their bodies during this period when the fetus cannot survive outside the womb any more so than society could – or should – force them to serve as a human tissue bank or to give up a kidney for the benefit of another.” In a footnote, McBurney added: “There is an uncomfortable and usually unspoken subtext of involuntary servitude swirling about this debate, symbolically illustrated by the composition of the legal teams in this case. It is generally men who promote and defend laws like the Life Act, the effect of which is to require only women – and, given the socio-economic and demographic evidence presented at trial, primarily poor women, which means in Georgia primarily black and brown women – to engage in compulsory labor, ie, the carrying of a pregnancy to term at the government’s behest.”

Fulton County Justice Robert McBurney issues a ruling in Sistersong v. Georgia that HB481 be struck down, reverting the state’s abortion laws to pre-HB481 times, in which abortion is permitted up to 22 weeks.

HB481 was passed in 2019 and took effect in 2022 after Dobbs was handed down that bans abortions in Georgia after 6 weeks.

[kimyoonmiauthor]

Settings Sketch

So Scrivener has a "Location" Template, but I thought it was rather weak, so I beefed it up to have more things to think on, but not necessarily fill out. I used my inner nerd, Sociology and Anthropology to make this one.

As a Scrivener Template, I set it up to look like this (with invisibles on)

Here is the list of items I put in.

I know most people will do maybe the Name, name origin, the Geography, but for me, I like to know the people who live there and how the place woks in a social setting to get the place to feel alive and breathe.

This is my city template. For other locations, like say a mountain or lake, you probably could cut the majority of the list.

For individual buildings, etc, I'm more inclined to post a picture of the layout.

My favorite parts of the building up the locations are the grunt workers over the professionals. It makes your locations feel alive when the village/town/city is changing in some way or other. There is construction, the sewer system failed, the cogs fells out of place, the steam isn't steaming, etc. So it's worth it to put a little thought into it. Oh noes, there is a pothole, so a construction crew has to fix it. Often other world fantasy neglects this part, but in a way, a city/town, etc is a breathing changing entity, so it makes it feel much more vivid when it is doing that and maybe a small action your characters do affects that indirectly.

BTW, while you're at it, be a bit more creative with your prison system. You don't have to say lock up people with mental health problems and the poor. You could actually restructure society so that there isn't a permanent homeless and prison population, or children running around without homes or supervision. All those institutions you have in your day to day life--you could challenge them change them because you're wolrdbuilding.

Here is the text for those that don't have Scrivener or your screen reader is failing you.

Name of Setting

General Information Graphemes:

Meaning:

Origin:

Nicknames:

Role in Story:

Type of Place:

Government Type:

Story Characters Associated:

Geographical Features Climate:

Soil Types:

Vegetation:

Water Resources:

Landforms:

Mineral Resources:

Geological Description:

Demographics Ethnicities:

Race:

Age:

Socio-Economic range:

Religions:

Population Numbers:

Population Density:

Political Landscape:

Economy Real Estate:

Finance:

Large Companies:

Production and Industry:

Buildings:

Economic History:

Community Schools: (How many? How many students pers school? What levels?)

Major Parks:

Mixed Use Locations:

Major Public Places:

Must-See Locations:

Unique Features:

Utilities and Public Works Lights: (Gas? Electricity Magic Fire) Water Works: (How does water get to your residents?) Safety: (Fire, Fire Warning, Law Enforcement, etc) Park Services: (Who cleans up the Parks, trims the trees, etc) Trash and Recycling Removal:

Public Transportation:

Mail:

Communication:

Street Cleaners:

Sewer System:

Health Services: (Out of Pocket, Public, Private, Types of Practitioners) Mental Health Services:

School System: (Public, Private, Home, Mixed? Who gets it?)

Sensory Information Sights:

Sounds:

Smells:

Taste:

Touch:

General Information History:

Notes:

[solarpunkbusiness]

Japanese family farm goes solarpunk

While Japan continues to drive the high-tech smartification of agriculture, what is the role of digitalisation for a diversified, agroecological family farm in a rural part of Hyogo Prefecture? Matteo Metta writes this report from Hashimoto Farm in Ichijimachō to share his observations on how digitalisation fits into the everyday life of this small-scale, mixed organic farm, as well as digitalisation’s role in the context of the increasing socio-ecological threats faced by the village, from typhoons and landslides, to depopulation and societal ageing.

The Hashimoto family is composed of four members: Hashimoto, Keiko and their two sons who now live outside the farmhouse. Volunteers, woofers, researchers, practitioners and interns from all over the world come here to work in exchange for learning organic farming in a Japanese rural setting. The 1.2 hectare farm is scattered in many disjointed plots. It is certified under the common organic certification (JAS). As an organic farm, they produce and directly sell any sort of local vegetables and rice. They rear chickens too, an important element for closing the organic nutrient cycle between the soil, human consumption and plants. Some of the seeds sown on the farm are locally selected, saved and exchanged with other farmers, while others are bought from the market. When organic seeds are unavailable, Shinji-san resorts to conventional ones. Besides farming and direct selling, the farm hosts and provides training and organic farming educational activities to school children, young people and adult farm workers.

Weekly open farmers’ markets (called “marché” in Japan) are not common in this remote village of rural Japan. Bigger discount shops or supermarkets can provide a variety of goods, including food products. Although some of Hashimoto Farm’s produce is used for self-consumption or donated annually to local charities for children and single mothers in need, the farm income depends on the selling of their organic produce mainly through two direct sale channels:

Shinzenha-ne, a cooperative buying, selling and delivering organic products.

Ashi no Kai, a small-scale network that connects consumers with producers and is specialised in home delivery of organic produce in the Hyogo and Osaka prefectures.

Consumer cooperatives are quite advantageous for farmers because they can reach bigger and more stable food demand from the whole prefecture instead of just the village and spend less time and energy physically attending local markets. Except for placing the exact demand of requested food in the box, the rest of the supply chain activities is in the charge of the consumer cooperative (receiving orders, food collection, assemblage of food boxes for each consumer, box delivering, billing, transferring payments, etc.).

“Digitalisation, as many technological innovations, is inevitable. We need to make it useful for us though. The problem is not the technology per se, but the system in which we live.”

Even if both cooperatives offer online means for consumers to select their products, much of the communication and transactions with consumers and farmers are still based on paper, phone calls and fax. Although this system might mean spending less hours inputting digital data, learning how to use a computer and relying less on external skills to maintain or repair any possible errors or damage, some of the limitations mentioned by Keiko-san about this direct selling system are:

Asynchronisation: the weekly orders made by the consumers through these two consumer cooperatives might not be automatically synchronised with the stock available on the farm.

Material and energy costs: paper is still circulating in these transactions, which often requires also expensive physical deployment of the operators or fax messages.

Overall, this farm-to-consumers’ door delivery system has been running for many years and is proven within the specific social, demographic and geographical conditions of rural Japan. Yet, this system is not error-free, e.g., mismatching order-farm stock, mismatching consumer quality expectation and farmers’ explanations of product defects, etc.

[trans-koupen-chan]

listen. listen. I need everyone who sees this post to know that the Swedish study that partially looked at crime rates among cis vs. trans people is being WILDLY misinterpreted and used with absolutely zero critical thinking to paint transgender woman as a violent “other.”

the study’s own author has come out and said “The individual […] who is making claims about trans criminality, specifically rape likelihood, is misrepresenting the study findings.”

having looked at both the study and the author’s comments myself, the only similarity between cis men and trans women is the conviction rate by population size, and this similarity is only seen when looking at trans women who had sex reassignment surgery before 1989, when fewer opportunities and resources were available to trans people in Sweden. The study also did not control for socio-economic status which is commonly understood as a MAJOR contributing factor in criminality.

Here’s another quote from the study’s author;

“The difference we observed between the 1989 to 2003 cohort and the control [1973 to 1988] group is that the trans cohort group accessed more mental health care, which is appropriate given the level of ongoing discrimination the group faces. What the data tells us is things are getting measurably better and the issues we found affecting the 1973 to 1988 cohort group likely reflects a time when trans health and physiological care was less effective and social stigma was far worse.”

I will not deny that trans people, both trans women and trans men, sometimes commit or are convicted of crimes. That would be unfactual of me. But I feel as though it’s basic common sense that being convicted of a crime does not automatically make someone a bad or violent or dangerous person — for example, shoplifting food that you otherwise couldn’t afford, or the case of trans woman Tara Wolf, where the judge themself admitted that Wolf was provoked but convicted her of assault anyways. It’s also worth noting that the woman who Wolf had an altercation with approached Wolf and others attempting to film them without consent and admitted to grabbing and kicking Wolf’s partner, highlighting again that there are many cases where a conviction is not a cut-and-dry good/evil situation.

If you believe that the results of this study — or that any one isolated incident — prove that trans women are inherently more violent and criminal than cis woman, I am here to tell you that is incorrect. Even if this paper that looks as though it proves this, which it does not in the eyes of its own author, that would still be insufficient evidence to draw such a broad and sweeping conclusion about an entire demographic group.

Painting any demographic as inherently dangerous and violent is an “othering” tactic that has been used against stigmatized groups and minorities (including radical feminists!) for centuries now. It is not progressive, even if you cite papers and statistics to “prove” it. If you’ve made it this far in the post maybe you should reconsider your stance on this.

(obligatory inclusion: if you believe trans woman are men and trans men are women that is bioessentialist and also not progressive. just to round off the post and make sure we’re clear. limiting people’s choices and basing the way they are treated by society on a few body parts they are born with is inherently antifeminist. no I will not argue about this point.)

[politicalprof]

In which I "write" an editorial on Trump for the New York Times:

I asked ChatGPT to "write an editorial in the style of the New York Times explaining why people in a diner in Columbia, Missouri like Donald Trump." This is its nearly-instantaneous reply.

ChatGPT:

Title: The Trump Appeal in Columbia, Missouri: Unpacking the Allure in the Heartland

In the heartland of Columbia, Missouri, where amber waves of grain stretch as far as the eye can see and the pulse of America beats strong, there exists a palpable affinity for Donald Trump that might seem perplexing to some coastal observers. As the clatter of plates and the aroma of coffee fill the air in the local diners, one cannot help but wonder: What is it about Trump that resonates so deeply in this part of the country?

Understanding the Trump appeal in Columbia requires peeling back the layers of socio-economic, cultural, and political dynamics that define the region. This landlocked state, often overshadowed by the coastal metropolises, has been experiencing its own unique set of challenges and opportunities. It is in this context that Trump's message found fertile ground.

First and foremost, the people of Columbia, like many others in the heartland, appreciate Trump's no-nonsense, tell-it-like-it-is approach. Trump's communication style, characterized by directness and simplicity, resonates with a demographic that values plain-speaking and authenticity. In a region where hard work and straightforwardness are cherished virtues, Trump's unfiltered rhetoric strikes a chord.

Moreover, the economic policies pursued during Trump's tenure left a positive mark on the local economy. The emphasis on deregulation and tax cuts played well with small business owners and farmers, the backbone of Columbia's community. For many, the Trump era symbolized an effort to unshackle businesses from bureaucratic constraints and stimulate economic growth from the bottom up.

Columbia's demographics also play a role in the Trump support phenomenon. This college town is not a monolithic entity; it comprises a diverse tapestry of residents, including conservative-leaning individuals who may feel marginalized in the more liberal academic environment. Trump's unapologetic conservatism appealed to these voters, who saw in him a champion of values they held dear.

Furthermore, Trump's promise to challenge the establishment resonated with those who felt left behind by the currents of change. In Columbia, as in many parts of Middle America, there is a sense that the political elite in Washington is out of touch with the everyday struggles of ordinary citizens. Trump's outsider status and pledge to "drain the swamp" garnered him support among those who sought a break from the status quo.

However, it's crucial to recognize that not everyone in Columbia supports Trump, and opinions on his presidency are as diverse as the city itself. The diner conversations may include both avid supporters and passionate critics, fostering a vibrant discourse that reflects the democratic spirit of the nation.

In conclusion, the Trump appeal in Columbia, Missouri, emerges from a complex interplay of economic factors, cultural values, and a desire for political change. As the nation grapples with its political divisions, understanding the reasons behind Trump's popularity in places like Columbia is essential for fostering empathy and constructive dialogue. Only by appreciating the diverse perspectives that shape our democracy can we hope to bridge the gaps that sometimes seem insurmountable.