tag:theconversation.com,2011:/au/topics/vulnerable-populations-25663/articlesvulnerable populations – The Conversation2024-03-26T16:03:55Ztag:theconversation.com,2011:article/2245532024-03-26T16:03:55Z2024-03-26T16:03:55ZZulu culture and sexual orientation: South African study reveals the health costs of stigma<p>Same-sex relationships are legal in South Africa and <a href="https://www.concourt.org.za/index.php/gay-and-lesbian-rights">protected</a> by the constitution. Unfair discrimination on the basis of sexual orientation is against the law. </p>
<p>But in practice many cultures don’t necessarily see this as a right.</p>
<p>Traditional Zulu culture, for example, perceives same-sex relationships and sexual intercourse as taboo and <a href="https://njas.fi/njas/article/view/185">unAfrican</a>. Statements like <a href="https://journals.sagepub.com/doi/pdf/10.1177/0146167209338072?casa_token=3Nlm_dy4VSAAAAAA:tsFKGVDS7M-aA6S7bf0WSEMP79fpblscX-UsoJ6oXi_G-VBMMicAAQVwROuOrvzsMm4JYDfjNu0CLdQ">“real men are not gay”</a> indicate some people’s ideas about masculinity and sexuality. </p>
<p>These cultural norms have profoundly negative effects on Zulu men who have sex with men.</p>
<p>This abuse often triggers <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843994/">depression, suicide and drug abuse</a>. </p>
<p>As a public health specialist with an interest in marginalised groups, I conducted <a href="https://journals.co.za/doi/full/10.31920/2634-3649/2023/v13n1a2">research</a> looking into the role Zulu culture plays in discouraging men who have sex with men from accessing healthcare. </p>
<p>Stigma rooted in cultural beliefs was rife and many of the men we interviewed were too afraid to go to a health clinic.</p>
<p>This research is a tool for policymakers to use to ensure better healthcare for marginalised communities.</p>
<h2>How we went about our study</h2>
<p>In South Africa, men who have sex with men are categorised as a <a href="https://southafrica.iom.int/sites/g/files/tmzbdl1136/files/documents/KeypopPolicybrief.pdf">key population</a>, a vulnerable group more likely to get sexually transmitted infections, due to their socio-economic isolation. </p>
<p>Our study participants were living in <a href="http://umlazi.co.za/what-is-the-population-of-umlazi/">Umlazi</a>, an urban area of least 400,000 inhabitants in the province of KwaZulu-Natal. The province is the home of the Zulu monarchy and the majority of Zulu people – the largest ethnic group in South Africa. More than <a href="https://www.worlddata.info/languages/zulu.php">13 million</a> people speak isiZulu as their first language. </p>
<p>Many Zulu people forced from “<a href="https://www.sahistory.org.za/place/umlazi">white” towns</a> during apartheid ended up in Umlazi. <a href="https://www.sciencedirect.com/science/article/pii/S2666154323000728#:%7E:text=The%20mushrooming%20of%20informal%20settlements,Isipingo%2C%20Amanzimtoti%2C%20and%20Jacobs.&text=Fig.,1.">Informal settlements</a> have also mushroomed around Umlazi as those desperate for work flock to urban areas in search of jobs. </p>
<p>In our study we interviewed 25 participants, men who have sex with men, between the ages of 21 and 55. They were representative of different areas of KwaZulu-Natal as they had roots in Ulundi, Nongoma, uPhongolo, eDumbe and Vryheid. </p>
<p>They shared their experiences in a very emotional way. They described how they were frequently forced to conceal their sexual orientation to avoid being rejected or discriminated against. Study participants were representative of different areas of KwaZulu-Natal as they had roots in Ulundi, Nongoma, uPhongolo, eDumbe and Vryheid. </p>
<blockquote>
<p>Culture is very stigmatising, discriminatory, and depriving. I grew up in a community where people see same-sex relationships as culturally taboo, so tell me, how would you come out in such a community? People create culture; instead of discriminating against same-sex relationships, these same people must accept and embrace them as cultural norms. (Funani) </p>
</blockquote>
<p>For some participants, the traditional rite of passage from boyhood to manhood at the age of 21 was a source of alienation and pain.</p>
<blockquote>
<p>At the age of 21 you are celebrated as a man in the Zulu culture … you are dressed like a Zulu warrior with skin, a spear, and a shield. I was deprived of this because they said I am not a man. … I became sick because of this and was admitted to the hospital for weeks. I almost lost my life because I was deprived of my rights. (Linda) </p>
</blockquote>
<p>Yet another participant spoke about his experiences of not being accepted:</p>
<blockquote>
<p>I don’t care about culture because the culture has let me down as a gay man. Culture does not respect me … I would have killed myself in the more conservative rural areas because the culture does not accept me. I have suffered so many mental health crises because of this. (Sanele) </p>
</blockquote>
<h2>‘I could hear them laughing’</h2>
<p>The men consistently cited fear of discrimination and a lack of understanding among healthcare providers as reasons they avoided health clinics. </p>
<blockquote>
<p>I went to my local clinic because I had a sexually transmitted infection and needed care. When being attended to by the nurse, I was asked some silly questions that did not feel like they were taking my medical history. Then I was reprimanded about my sexuality as being culturally wrong and needing to change, which made me decide never to use my local clinic again. (Lindani) </p>
</blockquote>
<p>Most of the participants related to these experiences.</p>
<blockquote>
<p>I had a sexually transmitted infection and went to my local clinic for medical care. Getting there, a nurse attended to me, and during the section, she walked away to a separate room, where she went to tell other nurses about me. I could hear them laughing. I took my bags and left the clinic and never went back. (Siyanda) </p>
</blockquote>
<p>The impact on the men’s health could be critical:</p>
<blockquote>
<p>I would rather die with my sickness than use such facilities. (Anele) </p>
</blockquote>
<p>Another said:</p>
<blockquote>
<p>Due to my outfit I was kept in the queue for a long time, and when I was finally attended to, the nurse asked me if I am male or female. I respectfully answered her, and she called her other colleagues to make fun of me. (Solomon)</p>
</blockquote>
<h2>Cultural sensitivity</h2>
<p>Collaboration with cultural influencers and community leaders is essential to protect the rights of men who have sex with men while honouring cultural values. </p>
<p>Such interventions should be culturally appropriate, holding in esteem and respecting the Zulu traditions and values, as well as embracing the full spectrum of health matters encountered by men who have sex with men. </p>
<p>Similarly, healthcare providers should receive training to support this community and establish discrimination-free healthcare environments. </p>
<p>Efforts such as these would promote inclusivity and healthcare access for all.</p><img src="https://counter.theconversation.com/content/224553/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ikekhwa Albert Ikhile does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Same-sex relationships in Zulu culture are perceived as taboo and unAfrican. Some men who have sex with men avoid seeking care at health clinics.Ikekhwa Albert Ikhile, Postdoctoral Fellow, University of South AfricaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648792021-08-03T15:46:21Z2021-08-03T15:46:21ZHow some countries are using digital ID to exclude vulnerable people around the world<figure><img src="https://images.theconversation.com/files/414056/original/file-20210802-32831-1onlpl2.jpg?ixlib=rb-1.1.0&rect=28%2C19%2C6361%2C3966&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/smart-id-card-form-lines-triangles-1277449342">Illus Man/Shutterstock</a></span></figcaption></figure><p>The world has become interconnected at a level we never before imagined possible. States, banking, communications, transport, tech and international development organisations have all embraced digital identification. The current conversation hinges on the need to speed up registrations to ensure that every person on this planet has their own digital ID.</p>
<p>We have not stumbled into this new age of digital data management unwittingly. International organisations such as the World Bank and the UN have <a href="https://unstats.un.org/legal-identity-agenda/">actively encouraged</a> states to provide citizens with proof of their legal existence in an effort to combat structural poverty, <a href="https://www.bbc.co.uk/news/blogs-magazine-monitor-30079580">statelessness</a> and social exclusion.</p>
<p>To achieve this, social policy has deliberately targeted poor and vulnerable populations – including indigenous and Afro-descended people and women – to ensure they get an ID card to receive welfare payments. By aiming to include marginalised populations, they are targeting groups that historically have faced systematic exclusion and have been barred from formal recognition as citizens. </p>
<figure class="align-right ">
<img alt="Sampul buku berjudul Legal Identity, race and belonging in the Dominican Republic: From Citizen to Foreigner (Identitas Hukum, Ras, dan Milik di Republik Dominika: Dari Warga Negara ke Orang Asing)" src="https://images.theconversation.com/files/412906/original/file-20210723-21-1so4qlw.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/412906/original/file-20210723-21-1so4qlw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=842&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412906/original/file-20210723-21-1so4qlw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=842&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412906/original/file-20210723-21-1so4qlw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=842&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412906/original/file-20210723-21-1so4qlw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1059&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412906/original/file-20210723-21-1so4qlw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1059&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412906/original/file-20210723-21-1so4qlw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1059&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Lorena Espinoza Peña</span>, <span class="license">Author provided</span></span>
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<p><a href="https://www.youtube.com/watch?v=sejxDeI9zYw">My research</a> has revealed how states can weaponise internationally sponsored ID systems. <a href="https://anthempress.com/legal-identity-race-and-belonging-in-the-dominican-republic-hb">The book</a> that has come out of this work – Legal Identity, Race and Belonging in the Dominican Republic: From Citizen to Foreigner – highlights how, in parallel with <a href="https://id4d.worldbank.org/">World Bank programmes</a> providing citizens with proof of their legal existence, the government introduced exclusionary mechanisms that <a href="https://theconversation.com/dominican-republic-has-taken-citizenship-from-up-to-200-000-and-is-getting-away-with-it-43161">systematically blocked</a> black Haitian-descended populations from accessing and renewing their Dominican ID.</p>
<p>For years, people of Haitian ancestry born in the Dominican Republic have found themselves in a fierce battle to (re)obtain their ID. Officials claimed that for over 80 years they had erroneously provided people born to Haitian migrants with Dominican paperwork and now needed to rectify this mistake. These people say they are Dominican. They even have the paperwork to prove it. But the state doesn’t agree.</p>
<p>These practices culminated in a <a href="https://theconversation.com/how-a-group-of-dominicans-were-stripped-of-their-nationality-and-now-face-expulsion-to-haiti-39658">landmark ruling</a> in 2013 that stripped Haitian-descended people born in the country of their Dominican nationality, rendering them stateless. In response, a <a href="https://www.reconoci.do/">fight-back campaign</a> called for the civil registry to provide all people of Haitian descent with their state-issued ID documents as Dominicans.</p>
<p>In a damning critique of global identification practices, my research has revealed how international organisations at the time “looked the other way” as the state began weeding out and then deliberately blocking Haitian-descended people from accessing their documentation.</p>
<p>Who was deemed eligible for inclusion in the civil registry (meaning Dominican citizens) and who was excluded as foreigners (the Haitian-descended) was considered a sovereign issue for the state to address. As a result, tens of thousands of people found themselves without documentation and subsequently excluded from essential healthcare services, welfare and education.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/U8xZpNG39oc?wmode=transparent&start=1" frameborder="0" allowfullscreen=""></iframe>
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<h2>Closing the global identity gap</h2>
<p>We are seeing similar cases of this kind of exclusion erupting around world. In June 2021, I organised <a href="https://www.sas.ac.uk/videos-and-podcasts/culture-language-and-literature/reimagining-conference-day-one">a conference</a> at the University of London called (Re)Imagining Belonging in Latin America and Beyond: Access to Citizenship, Digital Identity and Rights. In collaboration with the Netherlands-based <a href="https://www.institutesi.org/about-us">Institute on Statelessness and Inclusion</a>, the event explored the connections between identity and belonging, digital ID and citizenship rights.</p>
<p>It included a paper on the French citzens caught up in <a href="https://theconversation.com/a-french-windrush-when-french-caribbeans-were-treated-as-second-class-citizens-97144">BUMIDOM</a> – known as France’s <a href="https://theconversation.com/windrush-generation-the-history-of-unbelonging-95021">Windrush</a>. We also heard about legal challenges brought by non-binary people in Peru, the experiences of non-domiciled Cubans rendered stateless, and the “<a href="https://www.theguardian.com/us-news/2020/mar/16/anchor-babies-the-ludicrous-immigration-myth-that-treats-people-as-pawns">anchor babies</a>” debate over whether children born to undocumented migrants should be granted automatic access to US citizenship.</p>
<p>The event ended with an <a href="https://www.sas.ac.uk/videos-and-podcasts/culture-language-and-literature/reimagining-belonging-latin-america-and-beyond">international roundtable</a> that examined the use of digital ID registrations for discriminatory purposes in other parts of the world. This included discussions about vulnerable populations such as the people of <a href="https://www.theguardian.com/global-development/2019/aug/30/nightmarish-mess-millions-assam-brace-for-loss-of-citizenship-india">Assam in India</a>, the <a href="https://www.fmreview.org/preventing/brinham">Rohingya in Myanmar</a> and <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2018/08/03/heres-what-it-means-to-be-somali-in-kenya/">Somalis in Kenya</a>.</p>
<p>Debates like these are only going to <a href="https://privacyinternational.org/news-analysis/3395/uns-legal-identity-task-force-opportunities-and-risks">become more prevalent</a> over the next 10 years: a homeless man who can no longer travel on public transport because the bus company only takes card, not cash payments; an elderly African American woman blocked from voting because she cannot provide a federal-issued ID; or a woman told she has to stop working because the system has flagged her up as an “illegal” immigrant. </p>
<p>For people who find themselves excluded from this new digital age, daily life isn’t just difficult, it is almost impossible.</p>
<p>And while the need to speed up digital ID registrations is pressing, in this post-pandemic world we need to take a step back and reflect. Calls for <a href="https://www.theweek.co.uk/news/uk-news/953548/vaccine-passports-to-lockdowns-boris-johnsons-five-biggest-u-turns-on-covid">digital COVID passports</a>, biometric ID cards and data-sharing track-and-trace systems are facilitating the policing not only of people crossing borders but also, increasingly, of the populations living within them.</p>
<p>It is high time we had a serious discussion about the potential pitfalls of digital ID systems and their far-reaching, life-altering impact.</p><img src="https://counter.theconversation.com/content/164879/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eve Hayes de Kalaf is an Executive Committee Member of the Haiti Support Group, a UK-based advocacy group.</span></em></p>When it comes to civil registrations, some states are using exclusionary mechanisms to block anyone it considers undesirable, as happened to Dominicans of Haitian descent.Eve Hayes de Kalaf, Research Fellow, Institute of Commonwealth Studies, University of London, School of Advanced Study, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1518402021-01-18T23:10:58Z2021-01-18T23:10:58ZCaravan communities: older, underinsured and overexposed to cyclones, storms and disasters<p>News of <a href="https://www.abc.net.au/news/2021-01-19/storms-south-east-queensland-clean-up-flooding/13066962">storms</a> battering parts of Queensland and the threat posed by <a href="https://www.abc.net.au/news/2021-01-19/qld-tropical-cyclone-kimi-downgraded-damage-clean-up/13066964">Cyclone Kimi</a> reminded me of a recent experience I’d had.</p>
<p>A few months after <a href="https://www.abc.net.au/news/2018-03-18/cyclone-marcus-darwin-destruction-in-pictures/9560134">Cyclone Marcus</a> unleashed havoc on Darwin in 2018, uprooting trees and causing million of dollars worth of <a href="https://www.ntnews.com.au/news/northern-territory/cyclone-marcus-15-million-cleanup-effort/news-story/73a06d3f72c03c7aaad612bb7ddda5e7">damage</a>, I had reason to visit a local caravan park. </p>
<p>I was there to pick up an item I’d bought on Facebook Marketplace from an older long term resident of the park, Anne*, and we got talking about the cyclone.</p>
<p>She described how tents were blown away, property lost and that “none of us were insured, really. So we have to be on our own”. Other Darwin caravan park residents had had their caravans <a href="https://www.ntnews.com.au/news/northern-territory/agony-lives-on-for-some-territorians-five-months-after-cyclone-marcus-made-landfall/news-story/f1e13a961c562356f2471eb03a5e02ce">crushed by falling trees</a>, and were similarly uninsured.</p>
<p>These stories are anecdotal, but illustrate a broader problem. Communities living at the margins are often more vulnerable to disaster risk, a problem likely to be exacerbated by climate change. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/a-crisis-of-underinsurance-threatens-to-scar-rural-australia-permanently-129343">A crisis of underinsurance threatens to scar rural Australia permanently</a>
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<h2>Heat stress, floods, cyclones</h2>
<p>People with long-term tenure at caravan parks likely <a href="https://apo.org.au/sites/default/files/resource-files/2011-02/apo-nid128481.pdf">experience higher levels of disadvantage</a> than the population as a whole; many are <a href="https://search.informit.com.au/documentSummary;dn=077378025059191;res=IELFSC">unemployed or in lower paying jobs, and contending with serious health issues</a>.</p>
<p>As one <a href="http://inform.regionalaustralia.org.au/population-and-people/housing/item/residents-at-risk-stories-of-last-resort-caravan-park-residency-in-nsw-4">report</a> published by the St Vincent de Paul Society NSW put it: </p>
<blockquote>
<p>Caravan park residents often experience high levels of violence and abusive behaviour, substance abuse and addiction, problem gambling, mental illness and poor physical health in an unsupported environment. A common factor among many residents is a desperate feeling of loneliness. </p>
</blockquote>
<p>Many also often live with the threat of heat stress, floods, storms and cyclones. Many are underinsured. Some residents <a href="http://bsl.intersearch.com.au/bsljspui/bitstream/1/6055/1/Risk_and_reality_insurance_report.pdf">have reported</a> trouble trying to get insured.</p>
<p><a href="https://link.springer.com/article/10.1023/A:1013765303567">Research</a> has identified an urgent need to maximise safety and minimise property exposure at Australian caravan parks. An article published in the Australian Journal of Emergency Management <a href="https://ajem.infoservices.com.au/downloads/AJEM-16-01">noted</a>:</p>
<blockquote>
<p>Not all people will have the capacity to insure against flooding and often the very poorest of people will seek accommodation in caravan parks because of the low rents. However, the caravans, in which they live and contain their valuables, are structures that are more likely to be severely damaged as against the more permanent structures of contemporary houses.</p>
</blockquote>
<p>Some of this increased risk is due to the location of caravan parks. As a state engineering consultant put it in one <a href="https://www.sciencedirect.com/science/article/pii/S0264275116309088?casa_token=wkUg9ozj0xYAAAAA:y7lFMebo6gsAWaTFw8fjtehoWZ3i4RwnVGubGpXOiOkBJofVwmB7ABcOW3ZQWqzCU60i2PaazgVa">study</a>,</p>
<blockquote>
<p>things like caravan parks or holiday parks are often proposed to be located in areas that wouldn’t normally be considered for normal residential development […] There is often a push to have that sort of development in these low-lying, vulnerable areas.</p>
</blockquote>
<p>One <a href="https://www.tandfonline.com/doi/abs/10.1080/00049180301735?casa_token=RuURX8PFjRMAAAAA:4pUaNXR-DOfTGnLxGCeuaQdRXKX4_UNvW-atlsH0cVE4SkJGM9lVrKBAnProt74EF3ofwmRyUc_HQCI">study</a> on caravan parks in coastal NSW found many were highly exposed to flooding and that: </p>
<blockquote>
<p>many parks are ill-equipped to deal with flooding: a high turnover of park managers means that most have no direct experience of floods; attitudes of denial prevail; most parks have no means of raising community flood awareness; and the process of flood response planning is patchy and of poor quality. </p>
</blockquote>
<h2>Change is possible — and necessary</h2>
<p>One <a href="https://www.tandfonline.com/doi/abs/10.1080/00049180301735?casa_token=RuURX8PFjRMAAAAA:4pUaNXR-DOfTGnLxGCeuaQdRXKX4_UNvW-atlsH0cVE4SkJGM9lVrKBAnProt74EF3ofwmRyUc_HQCI">study</a> called for more regulation of parks and for park managers to be better equipped with the skills to manage disaster risk.</p>
<p>Urban planners in cyclone-prone areas could look to <a href="https://www.sciencedirect.com/science/article/abs/pii/0304392483900540">research</a> on which tree species are most “wind-firm” and least likely to be uprooted in a cyclone — and use this information to inform urban planting strategies. Simply advising caravan-dwellers not to park under trees won’t work, as trees provide much-needed shade to offset heat.</p>
<p>Finding better ways to reduce risk of heat stress to long term caravan residents will grow only more important as the climate changes.</p>
<p>Too often, management of <a href="https://www.tandfonline.com/doi/full/10.1080/00049182.2013.765348">private caravan parks</a> is seen as a problem for private property owners. </p>
<p>But as some researchers have pointed out, caravan parks sometimes operate as a <a href="https://www.tandfonline.com/doi/full/10.1080/02697450802522798">form of social housing</a>, and often house vulnerable populations.</p>
<p>Increasingly, local and state governments may need to play a larger role in ensuring the rights of long term caravan park residents to safe housing are protected, as climate change related disaster risk grows.</p>
<hr>
<p><em>Name changed to protect identity. This story is part of a series The Conversation is running on the nexus between disaster, disadvantage and resilience. It is supported by a philanthropic grant from the Paul Ramsay foundation. You can read the rest of the stories <a href="https://theconversation.com/au/topics/disaster-and-resilience-series-97537">here</a>.</em></p><img src="https://counter.theconversation.com/content/151840/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonatan A Lassa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Communities living at the margins are often more vulnerable to disaster risk, a problem likely to be exacerbated by climate change.Jonatan A Lassa, Senior Lecturer, Humanitarian Emergency and Disaster Management, College of Indigenous Futures, Arts and Society, Charles Darwin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1515702021-01-17T19:01:27Z2021-01-17T19:01:27ZDisaster season is here — do you have a Resilience Action Plan? Here’s how the small town of Tarnagulla built theirs<figure><img src="https://images.theconversation.com/files/374328/original/file-20201210-13-z4idno.jpg?ixlib=rb-1.1.0&rect=18%2C6%2C4007%2C3011&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Mittul Vahanvati</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Heatwaves, floods, bushfires: disaster season is upon us again. We can’t prevent hazards or climate change-related extreme weather events but we can prepare for them — not just as individuals but as a community.</p>
<p>One way to do that is develop what is known as a resilience action plan, or RAP. </p>
<p>A RAP is a way for communities (be they school-based, profession-based, or neighbourhood-based) to collectively assess their strengths and weaknesses ahead of coming disasters, identify priorities and build an implementation strategy.</p>
<p>Recent work with Tarnagulla — a small town that sits in a bushfire and heatwave-prone part of rural Victoria — offers an example. The community got together, applied for funding and co-produced with me (Mittul Vahanvati) a tailor-made <a href="https://cur.org.au/cms/wp-content/uploads/2020/07/final-report_jul2020_endorsed_lr-min-1.pdf">RAP for their town.</a></p>
<p>Their example highlights how small scale, grass roots action trumps waiting around for large scale, top-down climate action to shape our future. </p>
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Read more:
<a href="https://theconversation.com/rebuilding-from-the-ashes-of-disaster-this-is-what-australia-can-learn-from-india-130385">Rebuilding from the ashes of disaster: this is what Australia can learn from India</a>
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</p>
<hr>
<h2>The Tarnagulla story</h2>
<p>Tarnagulla is about 180 kilometres north west of Melbourne, and 40 kilometres west of Bendigo. Its population and economic prospects boomed during the 1850s goldrush, but by the 2016 Census, its population had dwindled to just <a href="https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/SSC22438#:%7E:text=In%20the%202016%20Census%2C%20there,up%205.8%25%20of%20the%20population">133 people</a> with a median age of 61.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/374333/original/file-20201210-23-v7lfib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/374333/original/file-20201210-23-v7lfib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/374333/original/file-20201210-23-v7lfib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=433&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374333/original/file-20201210-23-v7lfib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=433&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374333/original/file-20201210-23-v7lfib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=433&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374333/original/file-20201210-23-v7lfib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=544&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374333/original/file-20201210-23-v7lfib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=544&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374333/original/file-20201210-23-v7lfib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=544&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tarnagulla is a very small town.</span>
<span class="attribution"><span class="source">Linda Jungwirth</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The town relies on agriculture and animal husbandry, but faces myriad challenges, including: </p>
<ul>
<li>deteriorating Federation-era buildings, such as churches and community halls, with about 30% of houses unoccupied</li>
<li>poor transport infrastructure, including crumbling roads, only one bus stop, a bus that goes once a week to Bendigo</li>
<li>declining economic activity, with just one hotel, one post office and little to attract visitors</li>
<li>growing risk from storms, droughts and bushfires</li>
<li>a vulnerable population, with approximately 60-70% people living from pension to pension</li>
<li>limited access to health care facilities</li>
<li>insecure power and water infrastructure.</li>
</ul>
<p>The town is at risk of disappearing. Its people face real danger when fire, heatwaves or other natural hazards strike and there’s precious little disposable income to spend on future-proofing homes.</p>
<p>The trajectory for Tarnagulla is not unusual in Victoria. Determined to save it from being engulfed by climate-change related disasters, the community applied for and got a grant from the Victorian Department of Environment, Land, Water and Planning, through their Virtual Centre for Climate Change Innovation. </p>
<p>They used part of the money to engage one of the authors (Mittul Vahanvati), to co-produce a RAP for and by Tarnagulla community. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/374331/original/file-20201210-21-1337ven.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/374331/original/file-20201210-21-1337ven.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/374331/original/file-20201210-21-1337ven.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374331/original/file-20201210-21-1337ven.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374331/original/file-20201210-21-1337ven.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374331/original/file-20201210-21-1337ven.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374331/original/file-20201210-21-1337ven.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374331/original/file-20201210-21-1337ven.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Determined to save the town from being engulfed by climate-change related disaster, Tarnagulla applied for and got a grant from the Victorian Department of Environment, Land, Water and Planning to build a RAP.</span>
<span class="attribution"><span class="source">Linda Jungwirth</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Increasingly frequent and harsher heatwaves, bushfires and droughts</h2>
<p>We held eight workshops over two years in Tarnagulla, with project leaders from the local community meeting me (Mittul Vahanvati) monthly. Establishing mutual trust and a sense of collaborative design was crucial; the process doesn’t work when an outsider parachutes in and starts telling locals what to do. </p>
<p>We identified the town’s existing strengths (outlined below).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/374040/original/file-20201209-15-1eds5h7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A table listing existing strengths and assets" src="https://images.theconversation.com/files/374040/original/file-20201209-15-1eds5h7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/374040/original/file-20201209-15-1eds5h7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=554&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374040/original/file-20201209-15-1eds5h7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=554&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374040/original/file-20201209-15-1eds5h7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=554&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374040/original/file-20201209-15-1eds5h7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=696&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374040/original/file-20201209-15-1eds5h7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=696&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374040/original/file-20201209-15-1eds5h7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=696&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Existing strengths and assets in Tarnagulla.</span>
<span class="attribution"><a class="source" href="https://cur.org.au/cms/wp-content/uploads/2020/07/final-report_jul2020_endorsed_lr-min-1.pdf">Tarnagulla Resilience Action Plan.</a></span>
</figcaption>
</figure>
<p>We also talked about how climate change-related disasters — such as increasingly frequent and harsher heatwaves, bushfires and droughts — were causing problems locally such as</p>
<ul>
<li>power outages becoming longer and more frequent</li>
<li>the soaring cost of keeping the house cool</li>
<li>concerns the dam might burst in a flood</li>
<li>people going without water for five days in previous disasters and being forced to buy water to survive.</li>
</ul>
<p>The resulting RAP identified five main goals:</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/374981/original/file-20201215-20-1d7e5ak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/374981/original/file-20201215-20-1d7e5ak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/374981/original/file-20201215-20-1d7e5ak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=812&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374981/original/file-20201215-20-1d7e5ak.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=812&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374981/original/file-20201215-20-1d7e5ak.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=812&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374981/original/file-20201215-20-1d7e5ak.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1021&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374981/original/file-20201215-20-1d7e5ak.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1021&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374981/original/file-20201215-20-1d7e5ak.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1021&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The five main goals of the Tarnagulla RAP.</span>
<span class="attribution"><span class="source">Tarnagulla Resilience Action Plan.</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Local councillors, and representatives from the emergency management sector and the health sector got together to test out the RAP, its feasibility and whether it would help reduce loss and devastation of town during hazards.</p>
<p>It became clear a complete emergency evacuation plan would require the town having a safer shelter, improving key roads used to flee the town and ensuring comprehensive communication systems to help vulnerable people (such as older people, children or single people) during a disaster.</p>
<p>The town also identified the need for a change in mindset about risk, and better communication via social media. The local Landcare group also resolved to raise awareness abut conserving and developing drought-tolerant species.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KEMqlYPLo-A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>What were some of the concrete outcomes?</h2>
<p>The resulting resilience action plan was endorsed by the Tarnagulla community and launched in September 2020. Now, the town is working towards implementing it. </p>
<p>Thanks to the RAP, Tarnagulla was selected for a feasibility study looking at <a href="https://www.business.gov.au/Grants-and-Programs/Regional-and-Remote-Communities-Reliability-Fund-Microgrids/Grant-Recipients">using a microgrid</a> to deliver reliable and affordable energy, and assess whether the town would survive network faults due to extreme weather. </p>
<p>Many households invested or are investing in generators, solar panels, battery bank and ways to cool their house ahead of coming heatwaves, due to awareness gained during workshops.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/374332/original/file-20201210-19-ab2sx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/374332/original/file-20201210-19-ab2sx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/374332/original/file-20201210-19-ab2sx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374332/original/file-20201210-19-ab2sx7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374332/original/file-20201210-19-ab2sx7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374332/original/file-20201210-19-ab2sx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374332/original/file-20201210-19-ab2sx7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374332/original/file-20201210-19-ab2sx7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The resilience action plan was endorsed by the Tarnagulla community in September 2020.</span>
<span class="attribution"><span class="source">Mittul Vahanvati</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Another win, <a href="https://www2.education.vic.gov.au/pal/shelter-place-buildings/policy">separate but complimentary to the RAP</a> is the Tarnagulla Primary School hall being retrofitted to serve as a community heatwave and bushfire safe shelter. The school has provided out-of-hours school access for members of the local community who have nowhere else to shelter when fires or heatwaves strike. </p>
<p>The school community also raised funds to install a 12.6kW solar system, with a goal of making the school energy independent during power outages or heatwaves.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/374330/original/file-20201210-16-1cwx3f3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/374330/original/file-20201210-16-1cwx3f3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/374330/original/file-20201210-16-1cwx3f3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374330/original/file-20201210-16-1cwx3f3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374330/original/file-20201210-16-1cwx3f3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374330/original/file-20201210-16-1cwx3f3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374330/original/file-20201210-16-1cwx3f3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374330/original/file-20201210-16-1cwx3f3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The town has a clear, community endorsed plan for what’s needed for the future.</span>
<span class="attribution"><span class="source">Sitong Wei</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The process of RAP also built confidence and skills in community members, some of whom have since been elected in the local council or part of the planning committees. There, they are in a much stronger position to push for urgent capital works to improve footpaths, public toilets and shops and support retrofitting of homes.</p>
<p>There is still plenty to be done, much of it needing extra funding (and as is the case everywhere, COVID has hindered progress). But now the town has a clear, community-endorsed plan to protect lives and properties and enable citizens to transition towards a resilient future.</p>
<h2>Disaster resilience requires collective action</h2>
<p>Much of the discourse around emergency preparedness focuses on individual preparedness, which puts the financial and physical burden on each person to “be ready” when disaster strikes. In reality, collective action is required. </p>
<p>As one participant told us,</p>
<blockquote>
<p>We have realised that we are not alone in facing the present and anticipated challenges. There are new opportunities on the horizon to work together with other communities and projects.</p>
</blockquote>
<p>If we want to prepare for uncertain futures, each one of us should consider building a RAP with our community.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nobody-checked-on-us-what-people-with-disability-told-us-about-their-experiences-of-disasters-and-emergencies-151198">'Nobody checked on us': what people with disability told us about their experiences of disasters and emergencies</a>
</strong>
</em>
</p>
<hr>
<p><em>This article was co-authored by Leigh Mellberg (Principal, Tarnagulla Primary School) and George Filev (Country Fire Authority). It’s part of a series The Conversation is running on the nexus between disaster, disadvantage and resilience. It is supported by a philanthropic grant from the Paul Ramsay foundation. You can read the rest of the stories <a href="https://theconversation.com/au/topics/disaster-and-resilience-series-97537">here</a>.</em></p><img src="https://counter.theconversation.com/content/151570/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mittul Vahanvati's work on this Resilience Action Plan was funded by the Tarnagulla Alternative Energy Group (TAEG) through DELWP’s Virtual Centre for Climate Change Innovation (VCCCI) Grant, Tarnagulla Action Group and RMIT University - Urban Futures Enabling Capabilities Platform - Research and Innovation. She's currently working on the ‘Climate Resilience Honiara’ project, a 4-year long project, funded by the UNFCCC Adaptation Fund, administered by UN-Habitat and led by Professor Darryn McEvoy from RMIT University, providing scientific support. She is Co-convener of RMIT University Climate Change Transformations Research Group, Board member of Newlands and East Coburg Neighbourhood Houses (NECCHI), a member of the ‘Disaster Capitalism’ group of international researchers, an affiliated member of ‘InterAction’ (an alliance of non-profit organisations in US working on post-disaster shelter and settlements), an affiliated member of the Bushfire and Natural Hazards CRC (BNHCRC) and director of Giant Grass design studio.</span></em></p>The small fire and heatwave prone town of Tarnagulla got together, applied for funding and co-produced a resilience action plan so they’re better prepared for the next disaster.Mittul Vahanvati, Lecturer, School of Global, Urban and Social Studies, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1419652020-07-09T19:18:46Z2020-07-09T19:18:46ZCOVID-19 presents new obstacles for people who use service dogs<figure><img src="https://images.theconversation.com/files/346169/original/file-20200707-194396-1p223rh.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1356%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Normally, working dogs make life easier for people with disabilities. However, since the beginning of the pandemic, the barriers to accessibility have never been so great.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>While browsing through a Facebook group for guide, mobility and service dog recipients, a post by one of the members jumped out at me. “Did you dare to go out with your dog?” it asked. “Are you able to go out of your home?” Since the early days of the COVID-19 crisis in March, many have had their eyes glued to the news and are following government guidelines. But in all this turmoil, have we forgotten about citizens living with a disability?</p>
<p>I am a doctoral student at the University of Ottawa and a resource teacher for suspended or expelled students. I specialize in the areas of inclusion and service dogs. My research project allowed me to have Toulouse, an assistance dog from the Mira Foundation trained specifically for my special needs students. Since March 2019, she has been accompanying me everywhere and has helped me discover a reality that I didn’t expect.</p>
<p>As a researcher in this field, I am fortunate to have access to networks of assistance dog beneficiaries. With this article, I would like to offer them a public voice in order to draw a portrait of their reality since the beginning of the COVID-19 crisis.</p>
<h2>A lack of accessibility</h2>
<p><a href="https://cjds.uwaterloo.ca/index.php/cjds/article/view/355">Ableism</a> is the word used to describe the extent of multi-dimensional discrimination against people living with disabilities. People with working dogs are victims of it on a daily basis. Indeed, our society is designed for citizens without disabilities and de facto obliges people with disabilities to fight for their essential rights, such as accessibility, despite the provisions included in the <a href="https://www.canada.ca/en/canadian-heritage/services/rights-people-disabilities.html">Canadian Charter of Rights and Freedoms</a> and the <a href="https://laws-lois.justice.gc.ca/eng/acts/h-6/">Canadian Human Rights Act</a>, which “guarantee equal rights and freedom from discrimination to persons with disabilities.”</p>
<p>Normally, working dogs accompany these individuals and facilitate their daily life. However, since the beginning of the COVID-19 crisis, the barriers to accessibility have never been so great.</p>
<h2>The risks of exclusion are increasing</h2>
<p>Anne-Marie Bourcier is visually impaired and received her third guide dog from the Mira Foundation. With her dog, Machine, she routinely takes the bus and subway to go shopping or have lunch with a friend. Autonomy is the watchword for this duo. However, since the pandemic, they no longer go out in public. She wrote me a long email to let me know about her new reality.</p>
<blockquote>
<p>I don’t see how I could be autonomous with my guide dog in a grocery store. Where do the arrows start? Where are the sinks for washing hands? Am I going to graze someone? Are we going to make a mistake in the aisles? Is someone going to help me once I get there? My guide dog is used to going straight into the store. If we go in, will they tell us to get out and get in line? I think it’s quite complex.</p>
</blockquote>
<p>These questions remain unanswered for Bourcier and many others. The physical obstacles are major, especially for a dog that has not been trained to deal with the health crisis and prevention measures.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/340682/original/file-20200609-21191-1k1h3ov.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/340682/original/file-20200609-21191-1k1h3ov.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=906&fit=crop&dpr=1 600w, https://images.theconversation.com/files/340682/original/file-20200609-21191-1k1h3ov.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=906&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/340682/original/file-20200609-21191-1k1h3ov.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=906&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/340682/original/file-20200609-21191-1k1h3ov.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1139&fit=crop&dpr=1 754w, https://images.theconversation.com/files/340682/original/file-20200609-21191-1k1h3ov.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1139&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/340682/original/file-20200609-21191-1k1h3ov.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1139&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Machine is a Bernese mountain dog.</span>
<span class="attribution"><span class="source">(Anne-Marie Bourcier)</span></span>
</figcaption>
</figure>
<p>While we might assume that people give priority to those living with disabilities, the opposite is true. For example, another guide dog recipient explains that he often has to avoid people who do not give way to him.</p>
<h2>Dogs and social distancing</h2>
<p>Added to this are situations where the disability is not visible and the public believes that the dog is in training. Awareness campaigns on social distancing have been conducted by the CNIB Foundation.</p>
<p>In addition to the physical obstacles, there are also psychological obstacles. “At the hospital, I need my dog and my partner for my MRI. I had to negotiate for entry,” says Geneviève, a traction dog recipient. The mask makes it hard for her to breathe and she has to constantly adjust her tone of voice to give instructions to her dog. “I feel badly about taking her in. With the distancing, there is a fear of people and sometimes small alleys. I’m scared to go out again.”</p>
<p>Thus, the risk of social isolation is amplified for service dog users who have to stay at home and forget about their routine.</p>
<h2>The other side of the coin</h2>
<p>Despite the difficulties, there are some positive experiences. Several beneficiaries are happy that the implementation of social distancing rules means nobody tries to pet their dog, which usually happens several times per outing. This distraction may cause the animal to make a mistake, which could put the safety of the user at risk.</p>
<p>In fact, all of them are grateful to have a companion during this crisis. In spite of the isolation, the beneficiaries can count on the reassuring presence of their animal. Marie Eve Leduc is the mother of a child diagnosed with an autism spectrum disorder (ASD) who has an assistance dog. She is relieved to have had Amhara for her boy.</p>
<blockquote>
<p>During confinement, Amhara proved her worth. Since Arthur hasn’t returned to school, he’s spending a lot more time with her! He spends long moments holding on to her, talking to her, petting her.… The change in his habits went well, thanks to our dog! </p>
</blockquote>
<p>After several months of confinement, the reopening of stores has also made going out again easier.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/340695/original/file-20200609-21201-v0xhou.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/340695/original/file-20200609-21201-v0xhou.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=512&fit=crop&dpr=1 600w, https://images.theconversation.com/files/340695/original/file-20200609-21201-v0xhou.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=512&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/340695/original/file-20200609-21201-v0xhou.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=512&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/340695/original/file-20200609-21201-v0xhou.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=643&fit=crop&dpr=1 754w, https://images.theconversation.com/files/340695/original/file-20200609-21201-v0xhou.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=643&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/340695/original/file-20200609-21201-v0xhou.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=643&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Arthur holds Amhara, a black Labrador service dog.</span>
<span class="attribution"><span class="source">(Marie Eve Leduc)</span></span>
</figcaption>
</figure>
<h2>Solutions exist</h2>
<p>As the process of deconfinement continues in Canada, many recipients are concerned that they will be overlooked as the measures rarely take into consideration <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/people-with-disabilities.html">Canadians living with disabilities</a>. A few solutions are therefore suggested for them, including priority entry at all times, reserved hours and a shopping assistance service.</p>
<p><a href="https://www.hsdc.org/accessible-deaf-friendly-face-mask/">Masks with a transparent screen</a> or visors to allow deaf or hard of hearing people to read lips would be necessary in essential services, particularly at the reception desk. Finally, distancing could become permanent around recipients of working dogs.</p>
<p>In this wave of change, it is up to us to seize the opportunity to make our society a more accessible place.</p>
<p><em>The author thanks the beneficiaries of the Mira Foundation who have generously shared their photos and testimonials, as well as the Canadian National Institute for the Blind/Institut national canadien pour les aveugles for the illustration.</em></p><img src="https://counter.theconversation.com/content/141965/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Virginie Abat-Roy is doing research with the Mira Foundation. She has received funding from the University of Ottawa.</span></em></p>There is an increase in physical and psychological barriers to accessibility for service dog users in the COVID-19 era. However, solutions exist.Virginie Abat-Roy, Candidate au PhD en éducation, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1003742018-07-23T14:29:08Z2018-07-23T14:29:08ZThe HIV pandemic: time to recalibrate and target the weak spots<figure><img src="https://images.theconversation.com/files/228830/original/file-20180723-189310-pb058s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than 15 000 researchers, activists and policymakers descend on Amsterdam this week for the 22nd International Aids Conference.</span> <span class="attribution"><span class="source">Marcus Rose/IAS</span></span></figcaption></figure><p><em>HIV remains a global challenge. Between 36.7 million and 38.8 million people live with the disease worldwide. And more than 35 million have died of AIDS related causes since the start of the epidemic in the mid-1980s. Two years ago the International Aids Society and The Lancet put together a commission made up of a panel of experts to <a href="https://www.thelancet.com/commissions/global-health-HIV">take stock</a> and identify what the future response to HIV should be. The report is being released to coincide with the <a href="http://www.aids2018.org/About">22nd International Aids Conference</a> in Amsterdam. The Conversation Africa’s Health and Medicine Editor Candice Bailey spoke to Head of the International AIDS Society Professor Linda-Gail Bekker, who also led the commission, about its report.</em> </p>
<p><strong>What have we learnt about the global HIV response in the last 30 years?</strong> </p>
<p>The world had an emergency on its hands 30 years ago with the arrival of HIV. A huge amount of effort was put into trying to find solutions. And there were some incredible breakthroughs. First was the miracle of lifesaving antiretroviral treatment, the biggest game changer over the last three decades. Great strides have been made in rolling out the treatment. UNAIDS tells us that <a href="http://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf">22 million people</a> are currently on treatment. That’s truly remarkable.</p>
<p>But we’ve also learnt that relying on the current pace is insufficient. That’s clear from the figures. In some countries the incidence is rising, and in many parts of the world the incidence rate has stalled or plateaued. We are not seeing the downturn that we need to be able to reach the global goal of <a href="http://www.unaids.org/en/resources/campaigns/World-AIDS-Day-Report-2014">ending the HIV pandemic by 2030</a>. </p>
<p>The biggest lesson we’ve learnt is that we need to reinvigorate the prevention message especially since we have new tools to combat HIV transmission in many different settings. This includes <a href="https://theconversation.com/one-year-in-lessons-on-rolling-out-an-hiv-prevention-pill-in-south-africa-88255">Pre-exposure prophylaxis</a> (PrEP) – a daily antiretroviral that’s given to people who have a high risk of contracting HIV to lower their chances of getting infected – as well as treatment as prevention, which involves giving people living with HIV antiretrovirals to suppress their viral loads. </p>
<p>For a sustainable response and looking forward to the next era, it will be important to position our responses to HIV within the broader health agenda. Patients don’t only have HIV, they have other issues. There are mental health needs and there are sexual and reproductive health needs, so HIV treatment and care must fit into that broader agenda. This will enable a more sustainable response.</p>
<p>This is a challenge in many parts of the world where HIV is in a siloed response and people are only treated by HIV specific services. There needs to be a service delivery model that considers the broader health agenda. This goes beyond integration. We need to think about where can we take the lessons from HIV into other diseases. In the case of HIV, person centred and community-based care has become critical to ensure people get access to treatment. </p>
<p>The message is simple: the epidemic is far from over and it’s not time to disengage. We’re here for the long haul. To ensure we have a sustainable approach we need to recalibrate.</p>
<p>The commission is calling for a new way of doing business that will seek common cause with other global health issues. We understand that the HIV response will need resources. This will be a great way to get a double bang for the buck.</p>
<p><strong>What’s still going wrong?</strong></p>
<p>In many regions we have left whole sectors of the population behind. These include men who have sex with men, women who trade sex and people who inject drugs. They aren’t getting proper services because of policy, prejudice and stigma.</p>
<p>And different regional pockets need particular attention. One is in Eastern Europe and Central Asia where there has been a 30% increase in new infections since 2010. This is particularly concerning. Its clear that whole regions are being left behind because of politics, denial and stigma.</p>
<p>Here the administrations are not doing the evidence based thing – they are failing their people and the response. </p>
<p>Another pocket is West and Central Africa. These are countries that are not reducing rates of infection as quickly as we had hoped, often due to limited resources. Nigeria, for example, needs help with the reduction of mother to child transmission.</p>
<p>These are areas that are going to need attention, help and encouragement. </p>
<p>But we don’t want to put out the notion that we are in trouble across the world.</p>
<p>In East and South Africa, for example, we have made significant gains. There is still a lot to be done but the trends are going in the right direction. In many ways South Africa really is a good news story because its administration and politics favour an enthusiastic response to do the right thing. Domestic funding around HIV has increased. South Africa still has the biggest number of people in the world living with HIV – 7.9 million according to the <a href="http://www.hsrc.ac.za/uploads/pageContent/9234/SABSSMV_Impact_Assessment_Summary_ZA_ADS_cleared_PDFA4.pdf">latest HSRC report</a>. But the country is beginning to turn the ship around. That’s something we can be incredibly proud of.</p>
<p>There are, nevertheless, still pockets that need attention. For example, adolescent girls and young women under the age of 25 in KwaZulu-Natal are roughly three times more likely than men younger than 25 to be living with HIV. We have had them in our sights but we now need a concentrated effort to tackle HIV in this cohort otherwise we will miss the target.</p>
<p>We need to look at the evidence and where can we make an impact with integrated care. This would be through HIV programmes that are part of sexual and reproductive health along with economic empowerment initiatives such as getting girls to stay in school and making sure they have opportunities to make autonomous decisions about sexual and reproductive health. </p>
<p>Doing everything for everyone is a waste of money and time. We need to sharpen the tip of our response. We must put our responses where we get the biggest bang for buck and call on those resources that offer prevention and treatment. </p>
<p><strong>What are the biggest challenges between now and 2030?</strong></p>
<p>Resources are the constant challenge globally. We live in a world where politics is unpredictable. We need to constantly advocate for funding while diversifying funding opportunities.</p>
<p>The second challenge is stigma and discrimination. Policy and ideology that is counter productive also feeds into stigma and discrimination. We need to do to something about laws that criminalise behaviour, like sex work, and stigmas towards intravenous drug users, gay people and men who have sex with men. Decriminalising sex work in South Africa, for example, would go a long way to reduce stigma, enable services and help the public health approach. </p>
<p>Continuing to understand how to reach young women and girls and protect them socially and medically; those are also big challenges. </p>
<p>Finally, in South Africa there is a challenge to find men who are not in the health services and get them into care and onto treatment. We know that a suppressed viral load means no HIV transmission and so this should be on its agenda.</p><img src="https://counter.theconversation.com/content/100374/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Linda-Gail Bekker receives funding from various research funding agencies on a competitive funding basis.</span></em></p>The HIV epidemic is far from over and it’s not time to disengage, says International Aids Society President Linda-Gail Bekker.Linda-Gail Bekker, Professor of medicine and deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/714442018-01-30T16:27:42Z2018-01-30T16:27:42ZWhat happens to mothers whose children are repeatedly taken into care<figure><img src="https://images.theconversation.com/files/200786/original/file-20180104-26145-9wo56t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It hurts. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/home">from www.shutterstock.com</a></span></figcaption></figure><p>If a child is born to a woman who is addicted to drugs, the baby is often taken away from its mother. A new investigation by the <a href="https://www.bbc.co.uk/iplayer/episode/b09qn2wh/panorama-addicted-last-chance-mums">BBC’s Panorama programme</a> looked at the struggle some of these women go through to get their babies back. </p>
<p>Helping these mothers is not only the right thing to do, it can help address the record numbers of children going into care. My ongoing research with vulnerable mothers, who’ve had one or more children taken into care, reveals how many are subsequently abandoned by the system. </p>
<p>The number of looked-after children has risen steadily <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/664995/SFR50_2017-Children_looked_after_in_England.pdf">since the early 1990s</a>. The Children and Family Court Advisory and Support Service reported a 64% increase in the <a href="https://www.cafcass.gov.uk/news/2014/may/national-picture-of-care-applications-in-england-for-2013-14.aspx">rate of care applications made</a> between 2008-9 and 2013-14 – up from 6,488 to 14,599. </p>
<p>There are <a href="https://academic.oup.com/bjsw/article/44/7/1735/1718126/A-Marriage-Made-in-Hell-Early-Intervention-Meets">complex reasons behind the sharp rise</a>, though it followed the death in 2007 of “Baby P”, Peter Connelly, after months of abuse, despite numerous visits from authorities. His death placed a <a href="http://www.bbc.co.uk/news/education-11621391">spotlight on professionals</a> involved in child protection decisions. While local authorities responded with different strategies following the highly publicised case, all saw rises in care applications in subsequent years. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/201178/original/file-20180108-83563-pnul5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/201178/original/file-20180108-83563-pnul5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/201178/original/file-20180108-83563-pnul5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/201178/original/file-20180108-83563-pnul5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/201178/original/file-20180108-83563-pnul5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=477&fit=crop&dpr=1 754w, https://images.theconversation.com/files/201178/original/file-20180108-83563-pnul5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=477&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/201178/original/file-20180108-83563-pnul5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=477&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A marked increase in looked-after children.</span>
<span class="attribution"><a class="source" href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/664995/SFR50_2017-Children_looked_after_in_England.pdf">Department for Education</a></span>
</figcaption>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-some-children-are-more-likely-to-go-back-into-care-than-others-70181">Why some children are more likely to go back into care than others</a>
</strong>
</em>
</p>
<hr>
<p>The most common reason why children are removed from parents into care is neglect. This is often related to the underlying needs of the parents, who may have mental health problems, alcohol or drug disorders, or be in an abusive relationship. When a social worker or other professionals have safeguarding concerns around a pregnant woman, they may carry out a pre-birth assessment. If there is evidence that there is risk of significant harm to the unborn child, they can apply for a care order to remove the child from the mother shortly after birth. But it can vary depending where the mother lives, and different local authorities use different tools and timescales to assess these risks.</p>
<h2>Listening to mothers</h2>
<p>My research is highlighting <a href="http://shura.shu.ac.uk/13945/">how traumatic birth mothers</a> find the removal of their child, which often compounds multiple and complex problems. Women who had multiple pregnancies followed by the removal of each child experience a period of intense intervention from social services followed by a feeling of abandonment once the child is taken into care. </p>
<p>Most of the women I’ve spoken to are deprived in multiple ways. Some have been through the criminal justice system and are powerless to counter the decisions made by professionals involved in the removal of their children. Those mothers with a history of being in care themselves were also more likely to have their children removed. </p>
<p>One 33-year-old woman whose son was removed, and placed with a temporary foster family, just a few hours after birth told me:</p>
<blockquote>
<p>I’m finding it hard … How am I gonna carry on without my boy? My heart’s broke … I’m not gonna get through it. </p>
</blockquote>
<p>She was able to visit her son in a contact centre three times a week with supervised contact while waiting for a decision on the child’s future from the family court. This was her fifth child, the previous four were no longer in her care. Like other mothers that I spoke to she had experienced abuse as a child. She had also been the victim of severe domestic violence while she was pregnant, and was still in recovery from drug addiction. She told me:</p>
<blockquote>
<p>I want to be a mum now, I just want to settle down and live my life with [him] … It’s me past, and I know I’ve got a horrendous past, but people can change, but it’s just giving me that chance to show that I’ve changed … I’m just not being given that chance … I’ll never stop being labelled because of my past.</p>
</blockquote>
<p>One of the first attempts to measure the <a href="http://www.lancaster.ac.uk/news/articles/2015/research-reveals-family-court-recycles-one-in-three-young-mums/">scale of this issue in England</a> in 2015 found that in a sample of 7,143 women, 16% of birth mothers were caught in a cycle of repeat pregnancies and these women were linked to almost a third of all care applications. Researchers also found that a total of 22,790 children were connected to these mothers, because a birth mother was often linked to more than one child going through the system. </p>
<h2>A shift in child protection</h2>
<p>There are complex reasons behind these statistics. One factor has been the shift from <a href="http://www.tandfonline.com/doi/full/10.1080/09503153.2015.1014337?src=recsys">child welfare to child protection</a> which has changed the nature of social work. Rather than supporting children to remain within their families, the focus is on making parents who do not display acceptable behaviours more responsible, through risk assessments and interventions. </p>
<p>There is higher pressure from larger, more complex caseloads combined with a fear of getting things wrong – understandably so when major publicity accompanies this. As a result, social workers have less time to devote to each case and are more risk averse in their decision making. </p>
<p>A continued focus <a href="https://dspace.lboro.ac.uk/dspace-jspui/bitstream/2134/1614/1/lister_children.pdf">on the child</a> rather than on supporting better parenting is not new, but it appears to contradict the efforts of the government’s <a href="http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7585">Troubled Families</a> programme which aims to support parents in those families with multiple problems, rather than having a strict focus on child protection. </p>
<p>Emerging projects are trying to prevent recurrent births and removals into care, but these solutions often focus on <a href="https://www.suffolk.gov.uk/council-and-democracy/council-news/show/programme-to-support-suffolks-vulnerable-recurrent-mothers-shows-real-success">promoting long-term contraception</a> or <a href="http://www.projectprevention.org/united-kingdom/">sterilisation</a>. Such approaches raise many ethical questions, but also highlight a flaw in how the issue is being approached: it places little value on the life of the mother and her welfare.</p><img src="https://counter.theconversation.com/content/71444/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This article draws on the author's doctoral research and is funded by Sheffield Hallam University's Vice-Chancellor's PhD Studentship. This PhD is linked to the ESRC-funded 'Welfare Conditionality: Sanctions, Support and Behaviour Change' project. </span></em></p>It can be a destructive cycle for mothers whose children are taken into care.Larissa Povey, PhD Candidate, Centre for Regional Economic and Social Research, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/714792017-01-24T04:54:13Z2017-01-24T04:54:13ZCentrelink debt debacle is bad policy for mental health<figure><img src="https://images.theconversation.com/files/154001/original/image-20170124-8088-npxzq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The threat of Centrelink debt is one more stressor on already vulnerable people.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/560075098?size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>The controversial <a href="https://www.theguardian.com/australia-news/2017/jan/03/minister-defends-centrelink-over-welfare-debt-compliance-system">Centrelink debt recovery system</a> shifts the onus of proof about apparent debts onto disadvantaged and vulnerable people.</p>
<p>The automated system uses <a href="https://theconversation.com/why-centrelink-should-adopt-a-light-touch-when-data-matching-70989">matching data</a> from various government agencies to generate letters to those receiving, or who have received, Centrelink payments, claiming they owe the government money. People then only have a few weeks to respond to matters that may go back years.</p>
<p>The debt recovery system could hardly have been better designed to create conditions that cause chronic stress.</p>
<p>Its approach has potentially serious consequences. UK research shows when government policies placed new and onerous demands on people receiving welfare payments this led to an <a href="http://jech.bmj.com/content/early/2015/10/26/jech-2015-206209.short">increase in mental health problems, and in suicides</a>.</p>
<p>If this debt recovery program continues, it is quite possible we may see similar, adverse effects on people’s health in Australia. As such, the government should suspend the program and rethink its approach.</p>
<h2>How does stress affect health?</h2>
<p>Stress stimulates our senses and focuses our attention. Our heart rate and blood pressure increase to support rapid changes in behaviour. Occasional relatively mild bursts of short-term stress <a href="https://www.amazon.com/Descartes-Error-Emotion-Reason-Human/dp/014303622X">are useful</a> in navigating everyday social environments and our bodies are designed to deal with it. </p>
<p>The social causes of stress are complex, but in simple terms, people are <a href="https://www.ncbi.nlm.nih.gov/pubmed/15122924">more likely</a> to experience stress arousal in situations when they believe they lack control over a situation and/or fear a possible negative evaluation from other people.</p>
<p>Unlike short-term stress, chronic stress can have more serious, long-term health consequences. It <a href="https://www.ncbi.nlm.nih.gov/pubmed/20973623">occurs</a> when people are faced with repeated environmental stressors over time and do not have (or cannot see) a way to avoid or resolve the perceived problem. Chronic stress can cause <a href="https://www.ncbi.nlm.nih.gov/pubmed/19488073">changes in the brain</a> that lead to the onset of common forms of mental illness such as depression and anxiety disorders.</p>
<p>It is almost certain chronic stress plays a significant role in <a href="https://www.ncbi.nlm.nih.gov/pubmed/20973623">mediating the effects</a> of social factors – like low income, unemployment, unsafe living environments, poor conditions in childhood, or being subject to discrimination – on health and illness across populations. <a href="http://www.who.int/social_determinants/thecommission/finalreport/en/">Research shows</a> such “<a href="https://www.ncbi.nlm.nih.gov/pubmed/15781105">social determinants of health</a>” can undermine people’s mental and physical health.</p>
<h2>How does this relate to Centrelink?</h2>
<p>In light of evidence on stress and its social causes, Centrelink’s debt recovery program is highly likely to contribute to chronic stress among people already subject to socioeconomic disadvantage and/or other life demands. So it is likely to cause or exacerbate mental health problems and illness.</p>
<p>For a person with limited resources, receiving a government letter demanding payment of large debts and threatening legal action is very likely to undermine their sense of control over their life, especially given community legal centres are <a href="http://www.abc.net.au/news/2016-08-12/community-legal-centres-push-to-reverse-funding-cuts/7730694">simultaneously being</a> <a href="http://www.naclc.org.au/cb_pages/news/MediaReleaseMYEFOfailstohaltfundingcliffforCommunityLegalCentresandAboriginalandTorresStraitIslander.php">defunded</a>.</p>
<h2>Broader lessons for policy</h2>
<p>A broader aspect of this problem is the failure of policy makers and key mental health organisations to come to terms with the causal link between social conditions and mental health and illness. </p>
<p>My research with colleagues on Australian health policy has shown although mental health policies often acknowledge social determinants of mental health, they <a href="https://www.cambridge.org/core/journals/journal-of-social-policy/article/to-what-extent-do-australian-health-policy-documents-address-social-determinants-of-health-and-health-equity/BB5C219E2D0B05C7A80262DD1418A74C">mainly focus</a> on individualised responses through medication and therapy. </p>
<p>The lack of action on social determinants of mental health and illness allows governments to avoid responsibility for the adverse health impacts of policies, like the Centrelink program.</p>
<p>It also blocks much needed public discussion on the <a href="https://croakey.org/the-centrelink-debacle-and-a-longread-about-the-dangers-of-chronic-stress/">broader impacts of stress</a> in modern societies. It lets down the Australian public and obscures the potential for Australia to do far better than our current sorry <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0">performance</a> on mental health by pursuing a <a href="https://www.ncbi.nlm.nih.gov/pubmed/20943582">policy agenda</a> to create social conditions that support well-being for all.</p><img src="https://counter.theconversation.com/content/71479/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matt Fisher has received funding for research on Australian health policy from the Australian Research Council. He is affiliated with the Public Health Association of Australia, the Social Determinants of Health Alliance and the Australian Greens.</span></em></p>The controversial Centrelink debt recovery system is bad news for the mental health of the disadvantaged and vulnerable people it targets.Matt Fisher, Research Fellow in social determinants of health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/677442016-10-31T11:25:27Z2016-10-31T11:25:27ZInstitutionalised and raped: Moldova turns shocking case into bold example of justice for vulnerable victims<figure><img src="https://images.theconversation.com/files/143661/original/image-20161028-15783-17oil5f.jpg?ixlib=rb-1.1.0&rect=5%2C1101%2C1994%2C1242&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p>A trial court in Bălți, a town in the small eastern European country of Moldova, recently found 50-year-old Stanislav Florea <a href="http://crimemoldova.com/news/kriminal/medicul-nvinuit-c-a-violat-16-paciente-de-la-internatul-psihoneurologic-a-fost-condamnat-la-13-ani-d/">guilty</a> of raping 16 women over a period of more than a decade. The court sentenced him to 13 years’ imprisonment. </p>
<p>Moldova – which has a population of 3.5m – is <a href="http://www.worldbank.org/en/country/moldova/overview">Europe’s poorest country</a>. This trial has been particularly shocking because Florea was the psychiatrist in charge of the 400-bed social care institution in Bălți. His victims were female residents with mental health issues or other disabilities. </p>
<p>The conviction is important as it is the first of its kind in central and eastern Europe, where I have been working for 15 years. Over that time, I’ve heard about countless incidents of sexual violence in mental health institutions. It’s also important as an example of how people with particular needs are, and should, be treated by courts the world over.</p>
<p>The trial was fraught with difficulties. Instead of helping them, prosecutors scoffed at and berated the women. A human rights lawyer was deployed to help the women and get the prosecutor – and in turn the judges – to take them seriously. To their credit, the three trial judges listened to women labelled with mental health difficulties whose testimonies were at risk of being dismissed. The women were eventually taken seriously and the verdict verifies their version of what took place behind closed doors.</p>
<p>History tells us that detention breeds exploitation, violence and abuse. This is especially true when, as is the situation in Moldova, there is no independent and regular system of inspection. Florea was able to continue attack these women for such a long time because of the power he held as their doctor and as a respected member of the community. He used his power to threaten the women with seclusion and injecting them with large doses of neuroleptic medication. </p>
<h2>Global attention</h2>
<p>Earlier this year the UN Committee on the Rights of Persons with Disabilities issued a “<a href="http://www.ohchr.org/Documents/HRBodies/CRPD/GC/Women/CRPD-C-GC-3.doc">general comment</a>” on women and girls with disabilities. This document states that because of “stereotyping based on the intersection of gender and disability, women with disabilities may face barriers when reporting violence, such as disbelief and dismissal by police, prosecutors and courts”.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/143666/original/image-20161028-15816-pykzs6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/143666/original/image-20161028-15816-pykzs6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/143666/original/image-20161028-15816-pykzs6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/143666/original/image-20161028-15816-pykzs6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/143666/original/image-20161028-15816-pykzs6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/143666/original/image-20161028-15816-pykzs6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/143666/original/image-20161028-15816-pykzs6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/143666/original/image-20161028-15816-pykzs6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Bălți institution.</span>
<span class="attribution"><span class="source">Oliver Lewis</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Yet women with disabilities are <a href="http://fra.europa.eu/sites/default/files/fra-2014-vaw-survey-main-results-apr14_en.pdf">more likely</a> to become victims of violence. Three years ago the <a href="http://www.mdac.org">Mental Disability Advocacy Centre (MDAC)</a>, an international human rights charity that I run, sent information on Moldova to the <a href="http://www.ohchr.org/en/hrbodies/cedaw/pages/cedawindex.aspx">UN women’s rights committee</a>. The resulting <a href="http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CEDAW%2fC%2fMDA%2fCO%2f4-5&Lang=en">report</a> called on the Moldovan government to investigate all cases of sexual assault against women with disabilities in residential institutions. </p>
<p>The Moldova conviction illustrates how justice systems can – when they are under the spotlight – take into account the testimonies of women who the law has otherwise labelled as incompetent. </p>
<p>Victims of gender-based violence need to be offered specific psychological support to deal with trauma, potentially including treatment for <a href="http://www.aaets.org/article178.htm">post-traumatic stress disorder</a>. </p>
<p>The victims in this case were also institutionalised and had disabilities. Another complicating factor was that a public institution had breached their trust. In small and resource poor countries such as Moldova, there are few professionals up to the job of investigating.</p>
<h2>Closing institutions</h2>
<p>The Moldova case also highlights another disturbing problem. In order to reduce the likelihood of abuse like this happening, the Moldovan government is being called upon to get rid of the kind of institution that Florea ran – those that keep people with mental health issues locked up, away from the rest of the world.</p>
<p>In Moldova there are 2,200 people who are forced to live in <a href="http://mdac.org/en/olivertalks/2013/10/30/girls-and-women-disabilities-have-rights-too">13 psychiatric and social care institutions</a>. Across Europe there are no reliable data, but there are believed to be well over one million people languishing in institutions of this kind.</p>
<p>These establishments hark back to a bygone age when it was considered acceptable to warehouse people labelled as “mad” or “incompetent” to live their lives out of sight and out of mind. Segregation of people with disabilities is no longer acceptable anywhere in the world, and the global trend is to <a href="https://wcd.coe.int/ViewDoc.jsp?p=&id=1917847&direct=true">shift people out of institutions and into the community</a> with the support they need to flourish. Budgetary flexibility, policy reform and local leadership are all needed to create alternatives that work in any context. </p>
<p>Community living is not just a nicety – it is an enforceable right. The <a href="http://www.un.org/disabilities/convention/conventionfull.shtml">UN Convention on the Rights of Persons with Disabilities</a> is binding on Moldova, as it is on <a href="http://www.ohchr.org/Documents/HRBodies/CRPD/OHCHR_Map_CRPD.pdf">most countries</a>. The Convention requires governments to implement the right to live independently and be included in the community with the benefit of individualised services designed to prevent segregation and isolation.</p>
<p>The conviction of a serial rapist in Moldova has highlighted the horrors of sexual violence against women with disabilities, but has also reminded us about the consequences of institutionalisation. The women of Bălți may have had justice in the courtroom, but they also deserve inclusion in the community.</p><img src="https://counter.theconversation.com/content/67744/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Oliver Lewis is the Executive Director of the Mental Disability Advocacy Centre, an NGO mentioned in the article. </span></em></p>A doctor has been convicted of abusing vulnerable women in his care – because a court finally decided to listen to their stories.Oliver Lewis, Professor of Law and Social Justice, University of LeedsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/561762016-04-04T09:17:44Z2016-04-04T09:17:44ZA long road ahead to reduce HIV among South Africa’s sex workers<figure><img src="https://images.theconversation.com/files/114898/original/image-20160313-11261-16g5l79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Reuters/ Mike Hutchings </span></span></figcaption></figure><p>More than half the female sex workers in South Africa’s three largest cities are HIV positive – but less than one-third are on antiretroviral treatment, according to a newly released <a href="https://www.health-e.org.za/wp-content/uploads/2016/03/South-African-Health-Monitoring-Survey-An-Integrated-Biological-and-Behavioral-Survey-among-Female-Sex-Workers-South-Africa-2013-2014.pdfhttp://globalhealthsciences.ucsf.edu/sites/default/files/content/gsi/survey-female-sex-workers-south-africa-2013-2014.pdf">study</a>. </p>
<p>Over 90% of these women have voluntarily gone for HIV tests, received counselling and regularly use condoms with their clients. Yet they have not been able to access HIV treatment in equal numbers. </p>
<p>There are several possible reasons for this: </p>
<ul>
<li><p>Some may not have been eligible for antiretrovirals under previous treatment guidelines; </p></li>
<li><p>The need to work around the clock to survive means they may not have time to access clinics; </p></li>
<li><p>Or the stigma they experience at clinics may deter them from seeking regular care. </p></li>
</ul>
<p>These are some of the results of the South Africa Health Monitoring Survey done with female sex workers. It is the first HIV surveillance study of its kind in South Africa in over a decade. It fills one of the gaps in the statistics around the South African HIV epidemic – current and reliable data on female sex workers.</p>
<p>The results of the study have informed <a href="http://www.gov.za/speeches/address-deputy-president-cyril-ramaphosa-launch-south-african-national-sex-worker-hiv-plan">South Africa’s National Sex Work Sector Plan</a>, which aims to control the HIV epidemic among sex workers. It will use a combined strategy of peer education and improved access to clinical services, including antiretroviral treatment and Truvada for pre-exposure prophylaxis.</p>
<h2>Informing an HIV response</h2>
<p>The study, led by the University of California in partnership with the Anova Health Institute and the Wits Reproductive Health and HIV Institute, involved interviews with over 2,100 women. Each was asked to provide a blood sample for HIV and syphilis testing, and to answer a 45-minute questionnaire which included questions on:</p>
<ul>
<li><p>health and risk behaviours; </p></li>
<li><p>experiences of gender-based violence perpetrated by partners, clients, and the police; and </p></li>
<li><p>access to medical care and HIV health programming. </p></li>
</ul>
<p>What the statistics show is that currently very few female sex workers are benefiting from antiretroviral programmes. And it will be impossible to control the epidemic without dramatically increasing uptake among them. </p>
<p>The data also shows that putting HIV-negative female sex workers onto pre-exposure prophylaxis to prevent new infections would also be a benefit. </p>
<p>Pre-exposure prophylaxis has been proven to be very effective for people at risk of HIV. In 2015 South Africa and Kenya joined the US in approving the pre-exposure prophylaxis Truvada. <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1011205">Studies</a> have shown that it provides users with up to 90% protection provided it is taken consistently. In earlier studies it was shown to be less successful in women who did not take the drug daily.</p>
<h2>Study findings</h2>
<p>The study found that in the country’s largest city, Johannesburg, up to 72% of female sex workers are living with HIV. In Durban, this dropped to 54% and in Cape Town 40% of sex workers are HIV positive.</p>
<p>We should not mince words here: this is horrible.</p>
<p>But if there is any good news here, it is that over 90% of these women have been tested for HIV, and that nearly three-quarters of HIV-positive sex workers are aware of their status. It shows that sex workers try to advocate for their own health.</p>
<p>Sex workers are one of several highly vulnerable key populations that are often neglected in the fight against HIV due to social stigma and frequent criminalisation. In South Africa, as in most countries in the world, sex work remains criminalised. </p>
<p>The high prevalence shows that HIV epidemic among South African female sex workers is as bad or worse than its neighbours. Around 70% of Swazi female sex workers and 25% of female sex workers in Mozambique are living with HIV. </p>
<h2>Improving the uptake</h2>
<p>South Africa faces a steep challenge in getting 90% of HIV-infected female sex workers on antiretroviral treatment by 2020. This is despite the fact that female sex workers have access to many different sources of health care, including antenatal care, Department of Health clinics, and in some cases clinics that specialise in providing healthcare to sex workers. </p>
<p>South Africa is now following the World Health Organisation’s <a href="http://www.who.int/mediacentre/news/releases/2013/new_hiv_recommendations_20130630/en/">recommendations</a> for early treatment, which translates into anyone with a CD4 count of less than 500 being eligible for treatment. This means that instead of treating people when they are very sick, treatment may now begin while they are healthy in order to keep them healthy.</p>
<p>This also means that the vast majority of HIV-positive sex workers are now eligible for antiretrovirals.</p>
<p>But stigma and other structural barriers to regular clinical access will be much more difficult to tackle.</p>
<p>For too long, condoms have been the only prevention strategy. The high prevalence we are seeing now among female sex workers is one of the consequences of relying only on condoms. </p>
<p>Although condom use is important, it cannot be the only measure to end the spread of HIV. Although the vast majority (over 75%) of female sex workers reported using condoms with their last client, condom use with non-paying partners like husbands or boyfriends is much lower. </p>
<p>More options are now available. Failing to expand treatment or implement pre-exposure prophylaxis programmes means startling statistics such as those among female sex workers in South Africa will be seen for years to come.</p><img src="https://counter.theconversation.com/content/56176/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Lane receives funding from a cooperative agreement between the US Centers for Disease Control and Prevention (CDC) and the University of California, San Francisco. </span></em></p>In South Africa, female sex workers go for HIV tests, receive counselling and use condoms – but don’t access antiretroviral treatments. More options are now available and can change this.Tim Lane, Associate Professor, UCSF Center for AIDS Prevention Studies & Global Health Sciences, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/557242016-03-10T04:41:24Z2016-03-10T04:41:24ZEngaging with communities can help tackle poverty linked health problems<figure><img src="https://images.theconversation.com/files/114461/original/image-20160309-13709-11og5uj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is an urgent need to generate robust evidence that shows how the social determinants of health influence people’s abilities to protect themselves against health risks.</span> <span class="attribution"><span class="source">Reuters/Mike Hutchings</span></span></figcaption></figure><p>Communities can provide health authorities with essential information on how people perceive and experience health and risks, and how people engage with health systems in their areas. They can explain why people fail to use antiretrovirals despite their availability, or why domestic violence remains unreported. </p>
<p>More generally, asking communities about their health problems can help explain how social situations shape exposure to risk, which in turn determines health. This is information that is not available from sources such as a country’s vital registration system, which records births and deaths.</p>
<p>Health planning needs to take community views into account if it is to be more responsive to the situation of patients in a specific area, and towards uncovering the root causes of many common conditions.</p>
<h2>Looking beyond statistics</h2>
<p>South Africa’s vital registration system provides information on births, deaths and the medical cause of death. But such data doesn’t provide health authorities with insight into the socioeconomic context in which these deaths occur, or other contributing factors.</p>
<p>There is an urgent need to generate robust evidence that shows how the social determinants of health – discrimination, poor housing, unemployment and lack of education – influence people’s abilities to protect themselves against health risks. By examining these issues, the health of marginalised groups can be more accurately represented and tackled.</p>
<p>We developed a community-based study in South Africa to discover local knowledge on two causes of death: AIDS-related deaths and deaths due to violent assault. Our <a href="http://jogh.org/pdfviewer.aspx?pdf=documents%2Fissue201601%2Fjogh-06-010406.pdf">study</a> was published in the <a href="http://www.jogh.org/">Journal of Global Health</a>. </p>
<p><a href="http://www.nejm.org/doi/full/10.1056/NEJMsr1405012">Global statistics</a> reflect that South Africa accounts for 17% of the world’s HIV burden, although it only constitutes 0.7% of the world’s population. The country has the world’s <a href="http://www.intmedpress.com/serveFile.cfm?sUID=eb5d9fc6-3267-4737-ac8c-7d11b0b94164">largest antiretroviral</a> initiative covering more than 2.5 million people. The country’s disease burden is skewed towards vulnerable populations, especially the country’s <a href="http://www.hsrc.ac.za/uploads/pageContent/4565/SABSSM%20IV%20LEO%20final.pdf">black population</a>. </p>
<p>Social and structural drivers contribute to HIV/AIDS being a critical <a href="http://www.avert.org/hiv-aids-sub-saharan-africa.htm">public health challenge</a>. These include mobile populations, over-crowded settlements and exploitative migrant labour practices.</p>
<h2>Working with local communities</h2>
<p>In our study, three community groups were convened in the Mpumalanga province, where an established <a href="http://www.agincourt.co.za/">longitudinal health surveillance site</a> exists. A series of meetings was held with groups to identify and define the causes, treatments and problems around HIV/AIDS and violent assault. </p>
<p>The groups revealed the connections between social and health systems issues, and deaths due to HIV/AIDS and violence. These related to issues like the use of traditional medicine, alcohol and substance abuse, unstable relationships and debt. </p>
<p>We found that in some communities in Mpumalanga, financial dependence played a significant role, guiding women’s sexual relationships and determining how they dealt with HIV/AIDS and domestic violence.</p>
<p>Our study found that the need for financial security: </p>
<ul>
<li><p>stopped women from reporting domestic violence;</p></li>
<li><p>encouraged young, poor women to trade sex for money; and</p></li>
<li><p>encouraged women to have unsafe sex to avoid losing their partners. </p></li>
</ul>
<p>Several participants reported that risky sexual behaviour was common. Young people would trade sex for money for immediate financial gain at the expense of their longer-term health.</p>
<p>Many women were in relationships for financial security and this constrained their ability to practice safe sex. They would not suggest using condoms as this would make their partners suspicious of their fidelity. This would threaten their relationships with partners who supported them socially and financially.</p>
<p>There were also serious problems in clinics across communities when it came to confidentiality and sensitivity. The disclosure of people’s HIV statuses – and the stigma surrounding the disease – affected their willingness to seek treatment. This made it difficult to treat and report HIV.</p>
<p>A similar pattern played out in cases of violent assault. Women would rather resort to home-based therapies to treat their wounds and hide assaults from authorities. In this way they would not compromise their household stability and income. But such actions could have fatal consequences, as participants reported that some women were beaten to death.</p>
<h2>Using local knowledge</h2>
<p>Although these findings are not new, they confirm the important role that communities can play by providing data when they are routinely consulted as part of data collection in health and socio-demographic surveillance sites. </p>
<p>The research was based on the premises that health inequalities are socially constructed and determined. Engaging with people who are directly affected by these issues gives researchers and policymakers important knowledge for policy and planning. Ultimately, it improves the ownership – and management – of <a href="http://www.equinetafrica.org/sites/default/files/uploads/documents/PAR%20Methods%20Reader2014%20for%20web.pdf">health problems</a>. </p>
<p>Further work is underway where community perspectives are being used to begin a dialogue with health planners and policy makers. The objective is to bring together researchers, communities and health authorities to connect robust evidence with the means for remedial action.</p><img src="https://counter.theconversation.com/content/55724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucia D'Ambruoso receives funding from DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1) and is affiliated to the Umeå Centre for Global Health Research, which is supported by FORTE: Swedish Council for Health, Working Life and Welfare (grant No. 2006–1512). The Agincourt HDSS is supported by the School of Public Health, University of the Witwatersrand, South African Medical Research Council and the Wellcome Trust, UK (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z).</span></em></p>Interacting with communities can provide health planners with critical information that can help them solve health challenges in specific areas.Lucia D'Ambruoso, Lecturer in Global Health, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.