For more than 40 years, we have used the core building blocks of education to create a strong academic and social foundation for each child. Awarded "Best of Downers Grove Preschools" three years in a row, we offer a warm and caring environment where 3-5 year olds experience an exciting, hands-on, structured program with a spiritual emphasis.
@2015 Marquette Manor Christian Preschool | Managed and Powered by Ninja Enterprises LLC.


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Previous / Alonso: Lack of trust in Alpine F1 car costly at old-school Imola Next / Hamilton: Red Bull has better set of F1 strategy cards to play at Imola
Formula 1 / Emilia Romagna GP News
Russell explains "Pastor Maldonado moment" in Imola F1 qualifying
Adam Cooper
Apr 17, 2021, 6:00 PM
Williams Formula 1 driver George Russell revealed he had a "Pastor Maldonado moment" when he ran wide before starting his first flying lap in Emilia Romagna Grand Prix qualifying.
The 23-year-old Briton, who will start 12th on the grid at Imola, was switching to his Mercedes power unit's push mode in Q1 when he got sideways and ran across the gravel.
He was trying to leave the change to the last possible moment in order to gain the maximum benefit over his flying lap.
Reflecting on the concentration lapse, he compared himself to former Williams driver Maldonado, who made 58 F1 starts for the team between 2011 and 2013 in an eventful grand prix career that is remembered as much for the Venezuelan's proclivity for incidents as his one-lap speed.
Top 10: F1 one-hit wonders ranked
"It's no secret that Mercedes are struggling a bit with the battery deployment, and every single metre gives you a metre at the end of the lap," Russell explained after the session.
"So I wanted to go into that mode as late as possible, as in halfway through the corner, before I picked up the power.
"Tyres were a bit cold, I wasn't fully concentrated. It contributed to a Pastor Maldonado moment!"
Russell was able to recover later in the session and he progressed to Q2 in 14th place, although he only just got round in time to beat the chequered flag.
"I only crossed the flag by two seconds, I believe, two or three seconds," he revealed.
"I had Danny [Ricciardo] right behind me. He was planning to overtake me with the DRS.
"And due to the straightline speed I could stay ahead of him - I managed to speed up and stay ahead of him. Very relieved, but it was a good lap."
George Russell, Williams
Photo by: Charles Coates / Motorsport Images
Russell subsequently ran a very strong lap on medium tyres at the start of Q2. He felt so comfortable that he was tempted to have another run on mediums, but the team opted to save a new set for the race.
He thus went out on softs and logged 12th place on the grid.
"I actually wanted to do my second set on the medium tyre because I was P10 at the time, or P11, with a medium, which was quite surprising," he said.
"We obviously opted for the soft, and improved by three-tenths.
"It was still a very good lap, so all in all, really happy with Q2 to be in P12. It was better than expected before the session."
Russell is confident that he can make amends for last year's disappointment at Imola, when he lost a potential points finish with a crash under the safety car.
"I'd say the car is looking better for race trim than it is in quali trim," he said.
"We've got we've got fastest car on the straight, so it's all looking promising. But this is the true pace of the car.
"This may be one of our better circuits, but this is where I hope and expect to be for most of the season, in the mid-range of Q2 and hopefully at points fighting for Q3."
Alonso: Lack of trust in Alpine F1 car costly at old-school Imola
Hamilton: Red Bull has better set of F1 strategy cards to play at Imola
McLaren reveals launch date for 2022 F1 car
Why Pirelli's emergency F1 fixed supply rule looks set to stay
As the driver of Formula 1's medical car, Alan van der Merwe's job is to wait – and hope his skills aren't needed. JAMES NEWBOLD hears from F1's lesser-known stalwarts
The steps Norris took to reach a new level in F1 2021
The original F1 maestro who set the bar for Schumacher and Hamilton
Juan Manuel Fangio, peerless on track and charming off it, established the gold standard of grand prix greatness. NIGEL ROEBUCK recalls a remarkable champion
George Russell joining Lewis Hamilton at Mercedes this year gives it arguably the best line-up in Formula 1 – if it can avoid too many fireworks. After serving his apprenticeship at Williams, Russell is the man that Mercedes team believes can lead it in the post-Hamilton era, but how will he fare against the seven-time champion? Autosport heard from the man himself

redpajama_set_name: RedPajamaCommonCrawl


When Sunsets Inc. wanted to take its B.Swim brand in a different direction, it hired Stephanie Graves to set the course for the label.
For her second collection at B.Swim, Graves has taken inspiration from her Hawaiian roots, having spent long vacations with grandparents who lived on the Hawaiian island of Kauai.
During that time, Graves gained an appreciation for Hawaii's surf culture and even picked up some Hawaiian lingo. When she returned to her hometown of Minneapolis, she thought she was the only surfwear nut in the upper Midwest.
Fast-forward to this upcoming Spring 2018 swimwear season and Hawaii is still an inspiration for Graves. She hopes her take on the aloha spirit offers a point of difference for B.Swim and its "Hoku Fields" print. Hoku is the Hawaiian word for stars, and this print features stars and half-crescent moons on a black field. Gold foil on the stars adds some shimmer.
Koloa is the name of the Kauai town where Graves' grandparents lived. So, B.Swim's "Koloa Medallion" print is named after the town. It features a blue paisley-style print, which the designer said is a departure from the floral prints that can be a dominating feature of swimwear. "There are so many thousands of florals," she said. "It's overdone. I wanted to offer something different." Other pieces feature solid colors such as Moana gray, which is a bluish gray. In Hawaiian, Moana roughly translates as ocean.
Graves became the head designer of B.Swim after spending less than two years working as an associate designer for the prominent swimwear company Raj Swim, headquartered in Tustin, Calif.
Sunsets Inc. was looking for a new direction for its B.Swim brand when Graves took over the label's design, said Greg Stager, Sunsets Inc.'s president.
To give the line an added point of view, Graves added a wider variety of silhouettes. Styles range from modest silhouettes to those that offer "small coverage," but Graves still skirts the skimpiest looks seen in other swimwear collections. Tops range from typical triangle tops to high necks and tops with molded cups and removable cups. Separates retail from $48 to $104 for a one-piece.
Up next, Graves said she'd like to introduce more fabrics and more styles to change up the look of B.Swim.


● On some computers you may need to SAVE a sound file before you can play it (rather than play it straight from the browser).
Aust. War Memorial - Last Post. See also FAQ.
● "ROUSE" rhymes with "cows", but not with "mouse".
● "REVEILLE" rhymes with "valley", as in "rah-VALLey".
The LAST POST is played immediately before the silence.
The ROUSE is played immediately after the silence, except at a Dawn Service where the longer REVEILLE is played instead.
The ROUSE is commonly (though incorrectly) also called the REVEILLE.
Australian Army YouTube video of the Last Post.
Watch the Last Post ceremomy live each day at 4.55pm (Australian Eastern Standard Time) (YouTube) from the Australian War Memorial.
Hymns For hymns suitable for Anzac Day ceremonies see the ones listed on our page Hymns for Remembrance Day.
Modern song alternatives Go to Modern Anzac Day music.
Modern songs suitable for use in Anzac Day ceremonies were moved to a new page on 8 October 2015.


Yearbook pre-sales are now closed. Anyone interested in purchasing a yearbook will need to bring $39 cash in June on the date of distribution. A Backpack notice will be sent out prior to that date and announcements will be made to the students the entire week before distribution.


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Q: order of the data is not proper nodejs I am bit new to nodejs. I am building a facebook like application. Anyway, I am querying the database as shown in the code. but order of the records I console.log on the front end is jumbled and not proper and everytime is different. Can you please tell me where am I mistaking?
router.get('/home', isAuthenticated, function(req, res){
    var friendsIds = req.user.friends;
    friendsIds.push(req.user.id);
    var cbdone = 0;

    Status.find({statuserId : {$in: friendsIds}}, null, {skip : 0, limit: 5, sort: {_id: -1}}, function(err, statuses) {

        for (var i = 0; i < statuses.length; i++) {
            (function(currStatus){
                var currentStatus = currStatus;
                var a = currentStatus._id.getTimestamp();
                if(currentStatus.likedBy){
                    if (currentStatus.likedBy.indexOf(req.user.id) > -1) {
                        currentStatus.isLiked = true;
                    };
                    currentStatus.likersCount = currentStatus.likedBy.length;
                } else {
                    currentStatus.isLiked = false;
                    currentStatus.likersCount = 0;
                }

                Comment.find({statusId : currentStatus.id}, null, {sort: {_id: -1}}, function(err, comments){
                    for (var i = comments.length - 1; i >= 0; i--) {
                        comments[i].likersCount = comments[i].likedBy.length;
                        comments[i].isLiked = comments[i].likedBy.indexOf(req.user.id) > -1;
                    };
                    currentStatus.comments = comments;
                    cbdone++;
                    if(cbdone === statuses.length){
                        res.render('home2', {
                            user: req.user,
                            statuses: statuses
                        });
                    }
                });

            })(statuses[i]);
        };
    });
});

A: You should use Promise.all or Promise + co or async/await to make your aync calls' result in order.
Status.find({statuserId : {$in: friendsIds}}, null, {skip : 0, limit: 5, sort: {_id: -1}}, function (err, statuses) {
  co(function *() {
    const Comments = yield statuses.map(function (currentStatus) {
      var currentStatus = currStatus;
      var a = currentStatus._id.getTimestamp();
      if(currentStatus.likedBy){
        if (currentStatus.likedBy.indexOf(req.user.id) > -1) {
          currentStatus.isLiked = true;
        };
        currentStatus.likersCount = currentStatus.likedBy.length;
      } else {
        currentStatus.isLiked = false;
        currentStatus.likersCount = 0;
      }
      return new Promise(function (resolve, reject) {
        Comment.find({statusId : currentStatus.id}, null, {sort: {_id: -1}}, function(err, comments){
          if(err) return reject(err);
          for (var i = comments.length - 1; i >= 0; i--) {
            comments[i].likersCount = comments[i].likedBy.length;
            comments[i].isLiked = comments[i].likedBy.indexOf(req.user.id) > -1;
          };
          resolve(comments);
        });
      })
    });
 ......
    res.render('home2', {
      user: req.user,
      statuses: statuses
    });
  })

});

redpajama_set_name: RedPajamaStackExchange


The New Museum is the only museum in New York City exclusively devoted to contemporary art.
Founded in 1977, the New Museum is a center for exhibitions, information, and documentation about living artists from around the world.
From its beginnings as a one-room office on Hudson Street to the inauguration of its first freestanding building on the Bowery designed by SANAA in 2007, the New Museum continues to be a place of experimentation and a hub of new art and new ideas.


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Romania detains two Italians for child trafficking
Source: http://www.focus-fen.net
10 March 2011 | 14:06 | FOCUS News Agency
Home / Southeast Europe and Balkans
Bucharest. Romanian authorities have detained two Italians for child smuggling and using a false identity after they allegedly tried to illegally take a Romanian newborn to Italy, prosecutors said Thursday, AFP informs.
The two, a 45-year-old woman and a 57-year-old man, were detained late Tuesday in the central city of Brasov.
The Italians allegedly reached an agreement earlier this month with a nine-month-pregnant Romanian woman to register her baby under their names at birth, so they could leave the country with the newborn.
The Romanian gave birth in a private clinic in the eastern city of Bacau, where she was registered under the name of the Italian woman, local prosecutors said.
Prosecutors have asked for the Italians to be held in pre-trial detention for 29 days. A court will decide on the request later Thursday.
filed under: Italy


Be one of the first 100,000 to enter four product codes and you'll receive a $2 Dunkin' gift card. Plus, wake up your taste buds with a chance to win a $100 Dunkin' gift card.
Ends 12/28/18 at 12:59 p.m. ET. Limit one offer per person.
See Official Rules for all details.
It's free to join Coca Cola Rewards, and if you can get 4 codes, you get a $2 Dunkin gift card. That should take care of your morning coffee today.


Do you have responsibility for Medicare or Marketplace growth, risk adjustment or medical cost management? Now, consumers have more control over their health coverage decisions than ever before, and they expect a superior and engaging experience that is targeted and mindful of their individual preferences.
In order to meet the expectations of the new healthcare consumer, it's imperative that health plans get better at knowing who to target and how to build engaging relationships with their consumers. To do that, health plans should take an integrated, multichannel approach to their engagement activities, ensuring they deliver the right message to the right person at the right time. This level of understanding of the consumer in combination with targeted messaging and delivery is key to orchestrating a superior customer engagement strategy in ways that drive better outcomes for both the member and the health plan.
Connect with participants during the webinar as GuideWell Connect, GuideWell, and AHIP take the conversation to Twitter. Simply follow the handles and use the hashtag #GetROI!
Lisa Crawford, Vice President, Product Development & Operations Lisa is responsible for driving and optimizing revenue growth opportunities by developing new capabilities, products, and services for GuideWell Connect–a sales, marketing, and engagement company focused on driving results through health care consumerism. She has more than 15 years of experience in the health insurance industry, holding multiple leadership roles in IT, business operations, and product development. Prior to her current role, she served as Director of Information Technology at Florida Blue, where she was responsible for creating, communicating and executing, the company's IT strategy through web, cloud, and mobile application development. She holds a Bachelor of Science degree in Aerospace Engineering from Embry-Riddle Aeronautical University.
Arden Buchanan, Senior Director, Relationship and Database Marketing Arden leads the direct marketing and analytics teams at GuideWell Connect –a sales, marketing, and engagement company focused on driving results through health care consumerism. He has more than 20 years of experience in advertising and marketing, holding multiple roles across research marketing, database management, account management and creative services. Prior to his current role, he spent seven years at Anthem BlueCross BlueShield focused on marketing strategy and direct marketing. He holds a Bachelor of Arts from the University of Florida.


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Нижній Ука́н () — присілок у складі Ярського району Удмуртії, Росія.

Населення
Населення — 175 осіб (2010, 214 у 2002).

Національний склад станом на 2002 рік:
 удмурти — 81 %

Примітки

Посилання
 На Вікімапії

Населені пункти Ярського району
Присілки Удмуртії

redpajama_set_name: RedPajamaWikipedia


Have lightly used items that you don't use?
Received a gift with no gift receipt?
Holiday gift unused or received a duplicate item?
Have you exceeded the department store's return time limit?
Also high cash exchange rates % for gift cards and store credit.
Try Return It Here ™ in the Philadelphia area.
Send details / photo for a fast cash offer.


text:
Home > In Other News > Banks to hold loan fairs across 250 districts from Thursday
Banks to hold loan fairs across 250 districts from Thursday
PTI , Published : Oct 2, 2019, 5:05 pm IST | Updated : Oct 2, 2019, 5:05 pm IST
SBI is the lead banker in 48 districts across the country. Likewise, BoB is the lead banker in 17 out of 250 districts in the first phase.
During the four days beginning October 3, loans will be sanctioned for retail, agriculture, vehicle, home, MSME, education and personal categories on the spot. (Photo: File | Representational)
New Delhi: The first phase of 'Loan Mela', an outreach programme for providing credit to retail customers and MSMEs, will begin from Thursday across 250 districts across the country to meet demand during the festival period.
During the four days beginning October 3, loans will be sanctioned for retail, agriculture, vehicle, home, MSME, education and personal categories on the spot.
All banks, including State Bank of India (SBI), Punjab National Bank (PNB), Bank of Baroda (BoB), and Corporation Bank have geared themselves up to take advantage of festival season demand.
Simultaneously, it is holding Baroda Kisan Pakhwada during which most of its branches would focus on promoting farm loans, BoB said in a statement.
During the annual performance review earlier this month, public sector banks decided to undertake outreach exercise in identified 400 districts. Later, the private sector too expressed their willingness to join the initiative.
This is part of the systematic bank reform process which envisioned taking banks to doorsteps of customers.
These camps will provide a one-stop destination for MSMEs, small retail businesses and end customers to access all bank services, especially loans in auto, home, personal and business section.
While at one level it will help businesses to gear up for the festive season, it will also provide ready cash in the hands of consumers.
Needless to say, all prudent financial norms and due diligence will be followed by PSBs while disbursing loans, a top official of the public sector bank said.
Awareness camps will be held in these districts to let people know about the event.
For spreading information, the banker said, local vendor associations, commercial organizations and chambers of commerce may also be engaged to spread the message among merchants and customers.
In line with the government's thrust on Digital India, the initiative will focus on financial inclusion schemes and digital payment methods so as to encourage consumers and merchants to increasingly shift to these payment modes, the sources noted.
Apart from PSBs, NBFCs/HFCs/MFIs/SIDBI and private sector banks can also participate in the scheme.
The second phase will be in 150 districts and will be held between October 21 and October 25, just before Diwali.
loan fairs, loan mela, retail loan, agriculture loan, vehicle loan, home loan, msme loan, education loan, personal loan


If you are looking for a new or ongoing event that will absolutely test your resolve and might even become a sea of change for you as it was for professional racer and Sports Techie inspiration, Brad Fredericks, Spartan Race might be it. Watch this video about Brad by Film The Athlete: http://blog.spartanrace.com/film-the-athlete-brad-fredricks/.
Sports Techie is excited to have the opportunity to provide a free entry giveaway to someone in our community for any 2013 Spartan Race. The Rafflecopter requirements to enter are slack and not mandatory.
One event goal was to make adventure racing more accessible to everyone. Spartan Race has three levels of courses: 3 mile Sprint, 8 mile Super and 10 – 12 mile Beast. Participants will run, jump and shimmy your way over a dozen or more challenging obstacles and mud. Courses are uniquely designed to test your mental and emotional fitness and push you past Sports Techie limits.
Stadiums are packed with premier sports technology and Reebok Spartan Race is geared up to tour some of the country's greatest ballparks in 2013. After the competitive race at Fenway last year and Citi Field NY on April 13th, Spartan Race has created one-of-a-kind Sprints around Miller Field, Citizens Bank Park, and once again at Fenway Park.
Spartan Race founder, Joe De Sena, is traveling around the country giving out free Spartan Workouts at local gyms and facilities. You can sign up for the workout and also a free ebook, You'll Know at the Finish Line, by Spartan Race founders Joe Desena and Andy Weinberg, at the web site.
They outline the Spartan training philosophy, inspired by the courage and discipline of the Ancient Spartiates and dedicated to functional exercise, which requires neither equipment nor gym membership – just a body, a will, and the great outdoors.
Loaded with comprehensive workout strategies and heartfelt personal testimonies from Spartan Legends like Hobie Call and Lisa Demetriou, You'll Know at the Finish Line blazes the definitive trail for the long-lost sport of obstacle racing.
Sports Techie supports the Spartan Race mission to get you active, healthy, excited about change, and return to our ancient roots where running through woods, getting dirty, and facing adversity was part of everyday life. If you have entered the race, pictures and video clip recordings of your racing adventure can be filmed by your support team's smartphones and cameras, or via a GoPro type recording device strapped to your head or body.
Find results and photos at the 2013 Race Results page. Photos can take up to 7 days since over 100,000 photos are shot a race. Results are definitely posted sooner. For 2013, they changed their photo method, so on the Results page, to see your photos, search for your name or bib #, click on your name and you will see a "Race Photos" tab appear.
If you do not have photos under your name, click to try the Timeline here: http://pages.spartanrace.com/timeline.php.
The Washington State Spartan Race SPRINT is at the Washougal MX Park.
Sports Techie, Race as an individual, as a part of a team or both at Spartan Race. Whatever your level, Spartan Race promises to test your strength, stamina, and sense of humor. I was born a Spartan. These events are both family and kid friendly.
My brothers and I were born at the hospital near our home in Spartan Village, East Lansing Michigan, while my Dad attended Michigan State University and worked at the Athletic department. Needless to say, I bleed Spartan, my newborn baby son Kellan does too, and so will you after finishing the race.
Enter our complimentary Rafflecopter giveaway via the link below and you could win the free Spartan Race entry. Enter daily until July 30th at 12AM.
The Washington State Spartan Race SPRINT is at the Washougal MX Park. Whether you are at a Spartan Race in California, Virginia, and Philadelphia or Chicago, Milwaukee and Nebraska, or while vacationing in Hawaii, or anywhere else they are at in the United States, Canada or the UK, enjoy the experience and be sure to share any digital evidence with us on any of our social media network links below.
I am a Spartan Race rookie. Never participated before, but eager to do so.
I'm a rookie! Hope to win!


Of all the holiday signals of better things to come and approaching festivities, nothing brings it closer to mind than the appearance of those outstandingly red poinsettias showing up in the markets and viveros (plant nurseries). Even before the Christmas trees arrive, these plants are ready to adorn your home with spectacular color.
Yes, Noche Buenas really started here in Mexico. They are from the Euphorbia family, which means they contain a white milky sap. The most popular is Euphorbia Pulcherrima or the Christmas Flower. Here in Mexico, it is known as Noche Buena. These plants that are usually seen here locally are of the single red type; however they do come in doubles, triples, round balls of red called "Flaming Spheres" and many shapes in between. They also come in a creamy yellow often called white, as well as pink, salmon, variegated and spotted.
These are hybrids of the original traditional plant. Most of the doubles and spheres are not suitable for potted plants to be used in the home. They require an outdoor exposure and will bloom only after they reach a height of 2 meters or more. Also available but seldom seen here are the hanging basket type, miniatures that are no more than a few inches high, and trees that stand about one meter tall. New styles and colors are added each year as these plants become more and more popular. The newer varieties are also hardier for indoor use and their color is more intense.
Paul Ecke Poinsettias just over the border in San Diego County, California, is the largest supplier of Poinsettia plants in the world. He is responsible for many of the new colors and styles. They can supply plants in full bloom any time of the year, anywhere. I have used his plants for many floral photo shoots for the holidays, and these shots were done in July and September. They are always at the peak of their beauty, and are shipped anywhere in the world. Seeing potted Poinsettias in blossom in the middle of the summer in North Carolina or Mexico City is a treat, and totally unexpected.
Poinsettias are not poisonous. The sap can be irritating to skin and stomach for some people, but most find it harmless. Pets usually leave them alone because they taste terrible (so they tell me).
To bring these plants into bloom for the Christmas season, they must be forced into bloom with darkness. They must have long nights to bring out the color. The bright red of the plant is really not the flower at all but a bract. The actual flower is the tiny yellowish bud in the center. When choosing a good plant, look to see if these tiny buds are closed and not showing their yellow stamens. If the flowers are missing all together, the plant is well past its prime, and not a good choice. The tighter the buds the fresher the plant and the longer it will last. Look for plants with good, lush foliage. If it is showing signs of neglect like falling leaves or discoloration, it is also not a good specimen to choose.
The bright red bracts will discolor if they are placed in full sun, especially if they are wet.
Plants that are grown outside are the exception. They love the sun. Keep the soil moist but not wet on your holiday plant, and never leave them standing in water. They like a warm bright room, and do like fresh air, but not drafts. Our sun here in Puerto Vallarta is so strong on clear days -even in December that it is best not to put them near an open window where they can burn.
To save the plant for another season, cut it back when the flowers and bracts start to shed. Hold back on the water until it starts to show new growth. If placed in the garden or patio, it most likely will not bloom at holiday time, but later in the year.
If you have no life and are adventuresome or bored, and you want your potted Poinsettia to bloom on your schedule, here is what you must do. You can even have flowers for Easter if you want, just move the starting date. For December blossoms, start in September or the first part of October, put the plant from last.


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Agriculture, Business, Canada, Democracy, Development, Economics, education, Elections, Energy, Environment, Governance, Health, India, Investment, United States, Update on India's States
Update on India's States: November 22, 2016
by cogitASIA Staff • November 22, 2016 • 0 Comments
GST negotiations are deadlocked over the question of who will collect taxes from small and medium businesses; Andhra Pradesh students will pay in-state tuition at Ohio's public universities; Karnataka's winter legislative session begins; Telangana seeks overdraft approval to pay salaries during the demonetization crisis; and more.
Center-State relations
The center and states remain deadlocked over the question of which level of government will be responsible for collecting Goods and Services Tax (GST) from businesses with a turnover of less than $225,000 per year. While states want to be responsible for collection of tax from all businesses in this category, the center hopes to collect the tax from services-oriented business. The two sides failed to resolve the issue during an informal meeting November 20 between state finance ministers and Union Finance Minister Arun Jaitley; the next official meeting is scheduled for November 25. Failure to resolve this issue would make it impossible for Parliament to pass implementing legislation during the winter session. Source: Economic Times
State minister for human resources Ganta Srinivasa Rao and Ohio lieutenant governor Mary Taylor signed a memorandum of understanding (MoU) that allows Andhra Pradesh students studying in Ohio's public universities to pay in-state tuition. The program, which begins immediately, will cut tuition costs by 50 percent. Source: The Hindu
The Asian Development Bank agreed to a $500 million loan to fund construction of India's longest river bridge across the Ganges in Bihar. The 6-mile-long bridge will improve road connectivity between north and south Bihar. Source: The Hindu
Bihar registered a huge increase in electricity consumption over the last 11 years. Annual per capita electricity use rose to 258 units in 2016 from 70 units in 2005, while peak demand rose to 3,769 megawatts (MW) in 2016 from 700 MW in 2005. Source: Economic Times
Nothing critical to report this week.
Gujarat began migrating commercial tax payers from existing tax platforms such as value added tax to the new GST platform. The state will enroll about 466,000 traders using a Goods and Services Taxpayer Identification Number. Source: Business Standard
Inox Wind has won a second order from dye and pigment producer Roha Dyechem for windmills totaling 40 MW to form a captive power plant in Gujarat. The project will be commissioned by March 2017. Source: Economic Times
The Gujarat government launched a chain of 52 state-run pharmacies, named Deendayal Pradhanmantri Jan Aushadhi Kendra, that will sell more than 1500 generic drugs at a 40 to 80 percent discount. The state government plans 500 more such stores across the state. Source: Hindu Business Line
The Haryana government launched a Voluntary Disclosure Scheme which offers small-scale electricity consumers amnesty if they declare electricity meters that are defective or that have been tampered with. Consumers can turn in such meters until December 31, 2016. Source: Business Standard
Following a meeting between Haryana chief minister Manohar Lal Khattar and Ontario's minister of international trade Michael Chan, Haryana signed various agreements with Ontario province for collaboration in agriculture and food processing. Ontario and Haryana agreed to constitute working groups to further promote agriculture cooperation. Source: Daily Pioneer
China Fortune Land Development (CFLD) has submitted a proposal to the Haryana government for joint development of an industrial township at Sohna with investment of around $2.5 billion. Source: Economic Times
A 10-day winter session of the Karnataka legislature commenced in the border town of Belagavi on Monday November 21. The government will attempt to pass new house rules that will split each day's session into morning and evening sessions. By making members sign attendance twice a day, the move is meant to minimize disruption and protests on the floor of the chamber. Source: The Hindu
In a bid to lower air pollution, the Maharashtra cabinet approved the Thermal Power Plant Ash Utilization Policy, which seeks to curb transport of fly ash produced in coal-based thermal plants and identifies measures to utilize coal waste at the source. The government has announced cluster development of ash-based industries, such as cement, in the vicinity of thermal power plants; the industries will be given land, ash, and tax incentives. Source: DNA
Taxes on property sales in Maharashtra have dropped by 37 percent after the center demonetized 500 and 1,000-rupee notes. The state government's average daily earnings from property registration charges and stamp duty had reached $6.15 million, down from $9.56 million. Property transactions in India frequently feature under-the-table cash deposits. Source: Business Standard
The Rajasthan government has raised the dearness allowance for state government employees to 132 percent, up from 125 percent, backdated to July 1, 2016. The hike will benefit nearly 800,000 employees and 350,000 pensioners and will cost the state $110 million. Source: Economic Times
The Government of Telangana has signed an MoU with Microsoft under which Microsoft will help the state government explore cloud, machine learning, and mobile based solutions to improve citizen services, education, healthcare, and agriculture in the state. Source: Economic Times
Despite an overall revenue surplus, Telangana will seek overdraft approval from the Reserve Bank of India in order to pay employee salaries and meet day-to-day expenses during the financial crisis caused by demonetization. The state's revenues have been dwindling every day since November 8, when demonetization began. Telangana's finance department does not believe a more standard ways and means advance will be enough to meet the state's financial commitments. Source: Deccan Chronicle
A delegation of U.S. state officials led by the governor of Delaware met with Telangana IT and industries minister KT Rama Rao to discuss investment opportunities in the state as well as working with Telangana in skill development and other areas. Source: Money Control
The state government has ordered registrars to accept the newly invalid 500 and 1000-rupee notes until November 24 in order to allow residents to pay property registration fees. Source: Indian Express
Uttar Pradesh government approved power projects worth $113 million, including $18 million for improvement of power supply infrastructure in Lucknow. Source: Economic Times
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The Clerk of Courts is the filing office for all Criminal, Juvenile, and Dependency (Children and Youth involvement) court cases.
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Edit Person: Robert Grimes Davis (1819-1872)
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* '''1850-1859: Peruvian Consul General to Hawaii''' * '''1859: Police Magistrate of Honolulu''' * '''1864-1868: Associate Justice of the Kingdom of Hawaii Supreme Court''' == Biography == '''Robert Grimes Davis''' was an early lawyer and judge of the Kingdom of Hawaii who served many different posts for Hawaii and the Republic of Peru. He was also known as ''Lopaka'', the Hawaiian version of Robert. {{Showfacts biography}} Davis was born in 1819, in Honolulu to Captain William Heath Davis, Sr. and Hannah Holmes Davis, a daughter of Oliver Holmes, Governor of Oahu. His father, who arrived in [[Hawaii]] in 1812, was a Boston ship captain and one of the pioneer merchants of the sandalwood trade in the islands. He was given his middle name after Captain Eliab Grimes, a close friend of his father who was also once a privateer in the War of 1812.[2] His younger brother was William Heath Davis, Jr., who was an early settler of [[San Diego]]. After his father's death in November 26, 1822, Hannah Holmes remarried to another American merchant John Coffin Jones, who took the five-year-old Davis back to Boston in 1825. In the United States, he was given "a classical education" and raised in the household of an uncle who was a wealthy merchant in Boston, remaining there until he completed his schooling. He traveled for a time in Europe where he acquired the ability to speak French, Spanish and German.[5][6] For a time, he was a clerk on the Boston merchant ship Monsoon which traded in Monterrey and Yerba Buena (now San Francisco). He returned to Honolulu and went into the mercantile business, trading between Hawaii and California.[7][8][9][4][10] In 1850, Davis was appointed Peruvian Consul General to Hawaii by President Ramón Castilla succeeding James F. B. Marshall, who had resigned. He would hold this position for much of the 1850s. Davis resigned his post as Peruvian Consul upon his appointment as Police Magistrate of Honolulu in 1859.[18] Davis also served many governmental posts for the Kingdom of Hawaii. He served as Commission of Customs in 1853, Police Magistrate of Honolulu in 1859 and briefly served as a member of the House of Representatives, the lower house of the Hawaiian legislature, during the session of 1855. He was also a member of the Privy Council from 1863 to 1865 under the reign of Kamehameha V.[19][20][21] In 1852, he began studying law and shortly after became a well read lawyer. He also was appointed to succeed John Papa ʻĪʻī as the Second Associate Justice of the Supreme Court of Hawaii from February 16, 1864 until his resignation in July 8, 1868.[22][23] Serving alongside Chief Justice Elisha Hunt Allen and First Associate Justice George Morison Robertson, the effectiveness of the three men's terms in office were considered highly by their contemporaries. In 1873, a writer in the Hawaiian newspaper The Advertiser stated: The years during which the Bench wns occupied by the present Chief Justice with Judges Robertson and Davis as Associates, may justly be regarded as comprising me most satisfactory period in the history of our jurisprudence. These three legal minds, not each excelling in just the same points, combined to give us a Bench of a Court of law. The decisions of the full Court were then the decisions of three legal men, and were settled and founded on legal argument and authorities. In proof of this statement, it is satisfactory to know that the dicta of our Court during that period have been more than once quoted m foreign forums.[23] During his time in office, he would also published Volume II of Hawaiian Law Reports.[24] Between 1868 and 1869, after his term as Associate Justice, Davis and Richard H. Stanley served on a commission which compiled and translated the Penal Code of the Hawaiian Kingdom into Hawaiian and English.[7][25] == Marriage and Family == === 1st Marriage: Harriet Hammett === Davis married on March 23, 1843 to his cousin Harriet Swain Hammett (died 1858), daughter of Captain Charles H. Hammatt (spelling varied)[26] and Charlotte Holmes, with whom he had four children Elizabeth J., William Heath, Charles Hammett, and Charlotte Holmes Lelepoki Davis. # William Heath Davis (1846-) # '''[[Charlotte Holmes Davis (1852-1915)]]''' - married James A. King making Davis the grandfather of [[Samuel Wilder King (1886-1959)]], who became Governor of the Territory of Hawaii 1953–1957 and was the first person of Native Hawaiian descent to become governor. # Charles Hammett Davis (c1850-) # Elizabeth Davis (c1854-) === 2nd Marriage: Maria Sumner === He married secondly on August 1, 1862 to Maria Sumner Sea (1824–1908), daughter of Captain William Sumner and the widow of Henry Sea, with whom he had Maria and Robert Crichton Wyllie "Wally" Davis. He died on March 4, 1872 in Honolulu after suffering for several months from the dropsy.[7][34] After his death, Davis was buried at Oahu Cemetery. {{Showfacts children |children-g1=William Heath Davis (1846-) + Charlotte Holmes Davis (1852-1915) + Charles Hammett Davis (c1850-) + Elizabeth Davis (c1854-) |children-g2=Robert Wyllie Davis (1859-) + Maria Davis (c1862-) + John S.K. Davis (1865-) }} {{Siblings}} == Ancestry == Davis and his younger brother were one-quarter Hawaiian from their maternal grandmother Mahi Kalanihooulumokuikekai, a high chiefess from the Koʻolau district of Oʻahu. == References == == References == * {{PersonWP|format=link|lang=en|Robert Grimes Davis}} - Wikipedia * [[Robert Davis]] - disambiguation * [[Davis in Hawaii]] - * [[Coffin Family of Boston]] {{showfacts residences}} {{showfacts awards}}{{showfacts journeys}}{{showfacts workhistory}}{{showfacts military}}{{showfacts religious}}{{showfacts community}} {{footer}} [[Category:Native Hawaiian politicians]] [[Category:Members of the Kingdom of Hawaii House of Representatives]] [[Category:Members of the Kingdom of Hawaii Privy Council]] [[Category:Hawaii Supreme Court justices]] [[Category:Kingdom of Hawaii judges]] [[Category:Peruvian diplomats]] [[Category:People from Honolulu]]


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Contributing Organization University of Minnesota Libraries, John R. Borchert Map Library. Remove constraint contributing_organization_name_s: Contributing Organization Subject Wisconsin Maps Remove constraint subject_ss: Subject Creator Hatch & Co. Remove constraint creator_ss: Creator
University of Minnesota Libraries, John R. Borchert Map Library. (1)
General Minnesota Maps (1)
Minnesota Maps (1)
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Sewall, Joseph S., 1827-1917. (1)
Hatch & Co. ; New York (1)
Sectional map of the surveyed portion of Minnesota and the northwestern part of Wisconsin
Hand colored."Entered according to Act of Congress in the year 1857, by J.S. Sewall, in the Clerk's Office of the District Court for the Southern District of Minnesota."Includes view of Fuller House, St. Paul and advertisements for Caldwell, Whitney & Co., bankers, St. Paul and Henry Mckenty, realtor, St. Paul.
Sewall, Joseph S., 1827-1917.; Hatch & Co.
University of Minnesota Libraries, John R. Borchert Map Library.


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Нико Кауфман (; 24 июня 1916, Цюрих — 23 ноября 1996, там же) — швейцарский  и .

Сын композитора-дилетанта, работавшего врачом. Изучал клавир и композицию в Цюрихской консерватории у Эмиля Фрая, кроме того, в 1937—1939 гг. занимался у Владимира Горовица и считается его единственным учеником европейского периода; позднее также брал уроки у Дину Липатти. В 1945 г. выиграл Международный конкурс исполнителей в Женеве (двумя годами ранее был удостоен второй премии).

В послевоенные годы работал музыкальным руководителем и аранжировщиком известного швейцарского кабаре «Корнишон» (). Писал музыку для музыкального театра, балетных постановок, автор фортепианных сочинений и песен, среди которых важнейшим является вокальный цикл, написанный на 17 стихотворений Германа Гессе. Вёл музыкальный отдел в газете швейцарских геев «Der Kreis».

Под патронатом городской управы Цюриха действует Фонд Нико Кауфмана, присуждающий стипендии его памяти швейцарским музыкантам не старше 35 лет.

Источники

Ссылки

 Биографическая справка на сайте Центральной библиотеки Цюриха

Литература

 Steinle, Karl-Heinz. Der Kreis: Mitglieder, Künstler, Autoren. — Berlin: Verlag rosa Winkel, 1999.

Академические музыканты Швейцарии


text:
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Harm reduction for HIV prevention
Harm reduction programmes aim to prevent the spread of HIV and reduce other harms associated with drug use
Approaches include providing easy access to sterile needles to reduce infections from needle sharing, and replacing illegal opiates (such as heroin) with prescribed medicine such as methadone or buprenorphine under medical supervision
Australia, Switzerland and the UK have reduced the number of new HIV infections among people who inject drugs to practically zero through harm reduction initiatives
Despite the proven benefits, harm reduction services are not available in many countries and access is insufficient in most
Stigma and discrimination, the 'war on drugs', and lack of sustainable funding are all preventing roll out of effective harm reduction programmes
Explore this page to find out more about the impact of harm reduction on HIV, types of harm reduction programmes, community engagement in harm reduction, and barriers to effective harm reduction programming for HIV prevention.
Harm reduction refers to strategies that aim to reduce the harms associated with psychoactive drug use1, and is most widely associated with injection drug use.
The earliest forms of harm reduction promoted abstinence from drug use and put reducing its occurrence at the centre of substance use policy and interventions.2
The concept of harm reduction was reinvented in the early 1980s at the beginning of the HIV epidemic when healthcare workers started to provide clean syringes to people who inject drugs (sometimes referred to as PWID) rather than solely trying to achieve abstinence.3
Since then, there has been slow but steady progress in implementing harm reduction programmes as a component of the response to the HIV epidemic, with a wide range of initiatives tried to date in a variety of settings.4 The vast majority of these initiatives focus on injecting drug use although harm reduction in relation to other forms of drug use are increasingly being offered as part of HIV prevention programmes.
Despite overwhelming evidence of the effectiveness of harm reduction for preventing the spread of HIV and reducing other harms associated with drug use, global harm reduction service coverage remains insufficient. Of 179 countries where injecting drug use is present, only 86 provide effective harm reduction interventions in the form of opioid substitution therapy (OST) and/or needle and syringe programmes (NSPs) (48%), with little or no increases since 2014.5Moreover, of the countries where harm reduction services are available few have achieved sufficient coverage.
The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) strongly recommend harm reduction as an approach to HIV prevention, treatment and care for people who inject drugs. Specifically, they advocate for a comprehensive package including:
OST and other drug dependence treatment
HIV testing and counselling (HTC)
antiretroviral treatment (ART)
prevention and treatment of sexually transmitted infections (STIs)
condom programmes for people who inject drugs and their sexual partners
targeted information, education and communication for people who inject drugs and their sexual partners
prevention, vaccination, diagnosis and treatment of viral hepatitis
prevention, diagnosis and treatment of tuberculosis (TB).6
Impact of harm reduction on HIV
Worldwide, the benefits of harm reduction have been proven. Early implementers of harm reduction programmes such as Switzerland, the UK and Australia have reduced the number of new HIV infections among people who inject drugs to practically zero.7
More recently, the government of Nepal cut HIV prevalence among people who inject drugs from 68% in 2002 to 9% in 2017 by scaling up its harm reduction programme.8 Likewise, the implementation of harm reduction programmes in Xichang City in China cut the number of new HIV cases among people who inject drugs by 75%.9
An analysis of North America, Europe and Asia harm reduction studies found OST was associated with a 54% reduction in risk of HIV infection among people who inject drugs.10
Since 2008, HIV prevalence among people who inject drugs in Ukraine has more than halved with the rollout of harm reduction programmes, from 42% to around 20% in 2015.11 In contrast, in the Philippines where there has been little implementation of harm reduction programmes, HIV prevalence among people who inject drugs increased from 1% in 2008 to 29% in 2015.12
Harm reduction in Ukraine
Ukraine's HIV epidemic is concentrated among key populations, with people who inject drugs accounting for approximately 28% of those living with HIV in the country.13
The first harm reduction programmes were introduced in Ukraine in 2004. Since then there has been a significant expansion of harm reduction services, with more than 212,800 people who inject drugs reached in 2015, equivalent to around 62% of the drug users, and more than 19 million syringes have been distributed, provision levels that have remained stable as of 2018.14 HIV prevalence among people who inject drugs has reduced dramatically – falling from 42% in 2008 to around 20% in 2017.15Despite this success, harm reduction services in Ukraine face significant funding challenges as support from the Global Fund, on which these services largely rely, continues to reduce.
As part of Ukraine's Global Fund 2017-2019 grant agreement, the government has committed to take over funding for OST and HIV prevention programmes for key populations.16
In 2018, the government announced it would be funding OST for more than 10,000 people at 178 healthcare facilities.17 However, concerns have been raised around the quality of these services and how effective harm reduction will be when provided by a government that criminalises drug use, when compared to the non government organisations who previously delivered services.18
Cost effectiveness of harm reduction programmes
Research has shown that harm reduction programming is cost-effective
In the USA, the National Institute on Drug Abuse in the United States has described methadone treatment as 'among the most cost-effective treatments', saving between US$3 and US$4 for every dollar spent.19
Similarly, every dollar invested in NSPs in Australia is estimated to return four dollars in healthcare savings.20
Research carried out across eight countries in Eastern Europe and Central Asia found that investments in NSPs returned savings of between 1.6 and 2.7 times the original investment by preventing HIV and hepatitis C infections.21
This is echoed by modelling from the Harm Reduction Coalition, which found that spending US$ 400,000 (the estimated medical cost for one person living with HIV) on NSPs would prevent around 30 people from becoming HIV positive.22
A separate modelling study to assess the cost effectiveness of harm reduction in Belarus, Georgia, Kazakhstan, Republic of Moldova, and Tajikistan found increasing access to NSPs, OST, HCV screening, ART and effective HCV treatment to be cost-effective in Belarus, Georgia, and Tajikistan, and even cost-saving in Kazakhstan and Moldova over 20 years, compared with 2012/13 coverage levels.23
Types of harm reduction programmes
The following key harm reduction interventions are listed below. It is recommended these interventions are delivered as part of a comprehensive package of services that provides people who inject drugs with access to HIV prevention, treatment and care. See our pages on NSPs and OST for more detailed information.
Needle and syringe programmes (NSPs)
NSPs allow people who inject drugs to obtain new, sterile needles and other drug paraphernalia at little or no cost to reduce the risk of HIV infection. NSPs have the added bonus of preventing the transmission of other blood-borne viruses such as hepatitis B and C.24
In 2018, NSPs were available in 86 countries worldwide.25
NSPs can also serve as a crucial gateway to other HIV services. People who inject drugs engage with NSPs on a consistent basis, creating a number of opportunities to provide access to other forms of relevant healthcare such as OST, HIV testing and counselling, and treatment for HIV, tuberculosis, and hepatitis.26
Opioid substitution therapy (OST)
OST is the practice of replacing an illegal opiate (such as heroin) with a prescribed medicine such as methadone or buprenorphine that are typically administered under medical supervision.27 In 2018, 86 countries were implementing OST.28
In many places, OST has proved highly effective in reducing injecting drug use among opioid-dependent people, limiting their risk of HIV transmission.29 30Providing sufficient access to OST could prevent 130,000 new HIV infections outside sub-Saharan Africa every year.31
OST has also been found to improve access and adherence to ART, reduce instances of overdosing and associated mortality, lessen criminal activity and more generally, improve the physical and mental health of people who inject drugs.32 33 34
Drug consumption rooms
Drug consumption rooms (DCRs) allow people who inject drugs to inject under medical supervision. They enable an immediate response to overdosing and decrease the transmission of blood-borne diseases such as HIV through access to sterile injecting equipment and education on safe injection practices. They can also provide access to healthcare as well as HIV testing and counselling.35
In 2018, 11 countries were operating DCRs across 117 sites.36
Evidence regarding the effectiveness of DCRs as a method of reducing HIV transmission remains unclear and hard to estimate. However, DCRs are proven to be effective in reaching and maintaining contact with marginalised populations, groups that are disproportionately affected by HIV, as well as reducing the risks of injecting drug use and increasing uptake both of other harm reduction interventions such as OST.37
Insite, Canada
In 2003, Insite in Vancouver became North America's first legally sanctioned drug consumption room. Its opening was the result of a decade-long battle to implement drug consumption rooms in Canada.
The facility was opened under the condition that it operate as a pilot and be rigorously evaluated. More than 40 studies have since been conducted. These indicate the facility has helped to reduce public disorder, disease transmission and overdose, is cost effective, and is not leading to increases in crime or the promotion of injecting drug use, two arguments that those opposed to DCRs often make.
Despite its success, the facility was been heavily criticised by a number of public figures and organisations and an attempt to close Insite was brought to Canada's Supreme Court in 2008. The court ruled in the facility's favour and ordered that the federal government revise its policies to allow for the legal operation of DCRs nationwide. Although feasibility studies were then conducted in Montreal, Toronto, Ottawa, and Victoria, no new legally sanctioned DCRs opened.
In 2015, a change in government and a subsequent simplification of the laws around DCRs saw numerous municipalities move towards opening DCRs, in part driven by the country's increasingly visible opioid crisis. As of 2018, 26 sites have been opened, although public opposition remains strong in some parts of the country.38
"My visit to Insite… made clear these sites save lives and that is our goal in Seattle/King County. Keeping people alive gives them the opportunity to get treatment and begin their path to recovery."
- Seattle Mayor Ed Murray39
Preventing overdose
An estimated 167,750 deaths were directly associated with drug use in 2018; 76% of these were due to opioid use.40
The number of people dying of drug overdoses has increased significantly in recent years in some regions. In large part, this is due to rapid increases of opioid use in North America, although overdose rates are also increasing in Western Europe. The USA recorded the fastest ever annual rise of overdose deaths, with an increase of 21% between 2015 and 2016 alone to more than 63,600. In Canada, opioid overdose deaths have also dramatically increased.41
Naloxone is an opiate antagonist that reverses the effects of an opioid overdose. Its use in DCRs is increasingly effective, as immediate administration by supervisors reduces overdose deaths, and encourages future attendance at drug consumption rooms.42
A number of Naloxone programmes have been implemented that provide training, overdose management education, and 'take-home' Naloxone kits to people who use drugs and others who are likely to witness opioid overdoses. Researchers found survival rates of between 83-100% among people given Naloxone by non-medically trained people, suggesting peer-led overdose management is viable as a harm reduction intervention.43
The need for access to Naloxone to be scaled-up is more pressing than ever. Combining this with effective behaviour change communication, clean needles and OST has huge public health benefit potential.44[HP10]
Community engagement in harm reduction
Peer and community-led provision of harm reduction services has been proven to increase uptake in a variety of countries and settings.
Peer-led harm reduction
In one Vietnamese district, where 75% of the people living with HIV were people who inject drugs, programming moved from a traditional approach (using behaviour change communication, commodities provision and voluntary counselling and testing referral) to a peer-driven approach.
Two outreach workers (one from an HIV outpatient clinic and one from a methadone maintenance therapy clinic) recruited people who inject drugs, providing them with 'coupons' and other incentives and referrals for HIV testing services (and, where necessary, care and treatment). These initial recruits (or 'seeds') pass coupons to other people in their own networks, including other people who inject drugs and their sexual partners.
The programme resulted in improvements in tracking people through services, and increases in testing and diagnosis, from 94 people tested in 2013 (3% of whom tested positive) to 483 people tested in 2015 (7% of whom tested positive). In 2016, of the 11% of people tested who were living with HIV, 42% were enrolled in treatment.45
An Australian study, which assessed existing evidence on peer-led NSP provision and interviewed people who inject drugs, found participants expressed a strong need for peer workers in the delivery of NSPs. The advantages associated with peer-based NSPs was the friendly, knowledgeable and non-judgmental nature of the service, the experience peer workers possessed, and the way in which the experience of peers enhanced participants' interactions when accessing injecting equipment.46
Pharmacy sale of syringes
Many argue that pharmacies are an important but under-used resource in preventing the transmission of HIV and other blood-borne infections among people who inject drugs. Pharmacists are some of the most accessible healthcare professionals and are in an ideal position to reach this group who are often socially marginalised and wish to remain anonymous.47
Pharmacists can fulfil a number of harm reduction roles including the sale of condoms, educating on safer sex practice, selling clean needles and syringes, and dispensing oral methadone for opioid dependence.48
Research has shown how the sale of over-the-counter syringes to people who inject drugs can reduce HIV prevalence among this group. One study of 96 metropolitan areas in the USA recorded an average HIV prevalence of 13.8% among people who inject drugs in areas with anti-over-the-counter laws compared to 6.7% across areas without such laws.49
A different study from Tallinn, Estonia, reported that people who inject drugs found pharmacies convenient for acquiring syringes due to their extended opening hours and local setting. However, the study also reported stigma and discrimination from both pharmacists and other customers, with the idea of distributing free syringes to people who inject drugs negatively received by some pharmacists.50
A survey of 298 pharmacists in Indiana, USA found half sold syringes without a prescription to people who inject drugs, a practice that is legal in the state. However, pharmacies located in communities with high rates of opioid overdose deaths were far less likely to sell syringes without a prescription than those in communities with lower rates, suggesting there is a need to work with reluctant pharmacists so they understand the health benefits of increased syringe access.51
Harm reduction initiatives for amphetamine-type stimulants
In recent years, there has been a large increase in the use of illicit stimulants including amphetamine, methamphetamine and cocaine, with South Africa, the USA, Brazil and Thailand notable examples.52
Amphetamine-type stimulants (ATS) cause an elevated sex drive, and there is evidence of an increase in unprotected sex among people taking these drugs. As a result, the risk of HIV transmission from ATS-fuelled unprotected sex is rising in certain countries, the vast majority of which have concentrated HIV epidemics, and so is a particular concern for men who have sex with men, transgender people and sex workers.
Linked to this is a growing sub-culture of 'chem-sex' parties among men who have sex with men in Europe, Asia and North America in which ATS and a variety of other substances are used to facilitate, enhance and prolong sexual sessions with multiple partners.53
Interventions that address harms associated with stimulant use include substitution therapies, drug checking services, psychosocial support, condom, lubricant and drug paraphernalia distribution, services for sexually transmitted infections, income generation and housing support. However, ATS harm reduction programmes tend to be stand-alone projects, many of which go undocumented, meaning evidence as to their impact remains limited.54
Safer crack smoking resources
Smoking crack cocaine can lead to open sores, burns or cuts on the lips and in the mouth. Blood from these wounds can contaminate the 'stem' - usually a small metal pipe - and be passed on to the next smoker. If two smokers both have open sores then there is a risk of HIV transmission.55
As a result, some harm reduction agencies have distributed 'safe crack kits' to reduce the sharing of pipes and the use of broken ones. Like other harm reduction programmes, they enable drug users to access the appropriate healthcare and support.56
A study on the impact of safer crack smoking kits in Winnipeg, Canada found the kits resulted in a shift away from injecting towards smoking. The frequency of reported pipe sharing also fell, from 80% to 40%. While the study raised questions on the cost-effectiveness of the kits, it found clear evidence that distributing the kits increased contact and trust between healthcare staff and people who use crack.57
Other drug dependence treatment
Other interventions are recommended where non-opioid drugs are used and where OST remains unavailable.
Drug dependence treatment helps prevent HIV transmission by reducing the sharing of needles and syringes and high-risk sexual behaviours associated with drug intoxication, as well as providing HIV education and other HIV-related healthcare.58
For example, cognitive behavioural interventions, a type of counselling which focuses on changing patterns of thinking and behaviour, have been shown to decrease amphetamine use.59 When used in conjunction with OST, medically supervised drug withdrawal (detoxification) can assist with the withdrawal and reduce the discomfort of this process.60 61
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Barriers to harm reduction for HIV prevention
Harm reduction has been demonstrated as an effective and efficient way of preventing the transmission of HIV and other blood-borne viruses among drug users. However, a number of barriers prevent its implementation.
Criminalisation and the 'war on drugs'
A 'war on drugs' approach still prevails in many countries. This is despite repeated calls from those working in public health for a human rights-based approach to people who use drugs, coupled with a growing number of UN bodies and mechanisms recognising the need to provide harm reduction services for people who use drugs. For instance, in March 2018 the UN's Human Rights Council adopted a landmark resolution that calls for a comprehensive, human rights and health-centred approach to drugs.62
Law enforcement authorities continue to criminalise the possession of needles and syringes and mount 'crackdowns' on people who inject drugs even when they are seeking treatment or visiting healthcare centres for clean needles and syringes or other services. Criminalisation drives people who inject drugs away from health and HIV services and has a negative effect on HIV prevention and treatment outcomes.63 64
For example, in 2017 the Committee on Economic, Social and Cultural Rights criticised Russia's punitive approach towards people who use drugs, and the absence of harm reduction programmes, noting that this results in refraining from seeking medical treatment and becoming incarcerated, two factors that are helping to drive rising HIV rates.65
The criminalisation of people who use drugs helps to fuel stigma, discrimination, abuse and other rights violations in many settings, including within healthcare. For many people who use drugs, this creates a significant barrier to accessing services while perpetuating mental health issues that may, in turn, lead to situations and behaviours that increase drug users' vulnerability to HIV. For example, a study in Thailand found people who inject drugs were almost seven times more likely to avoid HIV testing if health workers had previously refused them treatment or services.66As well as having a detrimental impact upon people receiving treatment, stigma and discrimination also impacts upon those in the recovery process who may be drug-free but are still subject to prejudice in areas such as work due to their history of drug use. As a result, many advocate for stigma reduction initiatives as part of harm reduction programmes.67
The harm reduction funding crisis
One of the biggest barriers to harm reduction initiatives is a lack of sustainable funding, which forces programmes to downsize or run at a much reduced rate.68 69
International donors provide the majority of financial resources for harm reduction programmes to prevent HIV in low- and middle-income countries (LMICs), with the Global Fund accounting for two-thirds of international funding in 2016.70 However, the Global Fund's eligibility criteria means certain upper middle income countries do not qualify for funding. For example, Brazil and China are unable to receive Global Fund support, despite high HIV prevalence among people who inject drugs. Soon Indonesia, South Africa and India will be unable to receive support, which will have a significant impact on thousands of people who use drugs.71
According to Harm Reduction International, a 90% funding gap for harm reduction exists in LMICs.72 In 2016, US$188 million was allocated to harm reduction in LMICs, the same amount as in 2007. This is just 13% of the US$1.5 billion that UNAIDS estimates is required annually by 2020 to effectively respond to the HIV epidemic among people who inject drugs.73
What international funding for harm reduction does exist is increasingly being allocated to low-income countries, which means people in middle-income countries who use drugs are in danger of being left behind in the global HIV response. While domestic investment in HIV programmes is increasing in some LIMC countries, few are prioritising HIV prevention for key populations. Among those governments reporting to UNAIDS on HIV prevention spending, only 3.3% of total HIV prevention funds were directed towards programmes for people who inject drugs in 2016.74
Even in the European Union, where harm reduction approaches began, funding for domestic harm reduction programmes is uncertain and being cut in some places.75
In contrast, spending on global drug enforcement and control dramatically outweighs spending on harm reduction. Data modelling by Harm Reduction International and the Burnet Institute suggests that, if 7.5% of the US$100 billion spent annually on drug control was used for harm reduction, by 2030 HIV among people who inject drugs would no longer be a public health issue.76
Harm reduction in Kazakhstan
There are around 120,500 people who inject drugs in Kazakhstan, 9% of whom are thought to be living with HIV.77
Despite the country's HIV epidemic being concentrated among key populations, with injecting drug use accounting for a large proportion of people living with HIV, reduced Global Fund funding and limited political support has seen OST restricted to pilot programmes at 10 sites across three cities, with less than 1% of people who use drugs accessing the programme.78
As of 2018, just 322 people were enrolled in the country's OST programme and the government has announced the OST pilot will not be expanded to other regions of the country. This is despite the OST pilot programme in Pavlodor, north-eastern Kazakhstan resulting in 100% adherence to ART among all those using the service who are living with HIV.79
As of 2018, 144 NSPs were operating in Kazakhstan. However, there are some concerns poor-quality syringes being distributed by government-funded programmes may be increasing the risk of unsafe injecting.80
Limited provision in prisons
High HIV prevalence among people in prison is well documented, as is the over-incarceration of people who use drugs and other key populations. The number of people incarcerated is also growing rapidly – since 2000, the world prison population has grown by 20%, faster than the increase of the general population (18%).81
Risky sexual behaviour, sexual violence, unsafe injecting drug use and inadequate healthcare all increase the risk of HIV transmission in prison settings. Despite this, harm reduction interventions in prison are severely limited. In 2018, 10 countries provided an NSP in at least one prison (Armenia, Canada, Germany, Kyrgyzstan, Luxembourg, Macedonia, Moldova, Spain, Switzerland and Tajikistan) and 54 provided OST.82
Access to HIV testing is poor in the majority of prisons around the world. Despite the fact that people who are newly released from prison face a heightened risk of overdose, only five countries provide Naloxone to people in this situation (Estonia, the UK, the USA, Canada and Norway). Even among these countries coverage varies considerably.83
The lack of NSP services in prisons is particularly concerning due to the high rates of injecting drug use and the complex interaction of HIV, hepatitis and TB in prisons worldwide.84
The future of harm reduction for HIV prevention
As more innovative harm reduction programmes and interventions are piloted, and in some cases implemented more widely, the potential harm reduction offers in reducing new HIV transmissions and providing a wider array of other health benefits becomes clearer and clearer. Yet a lack of political and financial support for harm reduction means the progress that could be made is likely to be lost.
As evidence is building on the increasing presence of people who inject drugs across the world, the need for harm reduction has arguably never been greater. But, if not addressed, the funding gap for harm reduction facing LMICs will continue to impede progress significantly.
In sub-Saharan Africa, a part of the world not historically associated with injection drug use, around 1 million people are now estimated to inject drugs and support for harm reduction is beginning to grow.85 Countries such as Mauritius and Kenya are leading the way on the implementation of government-backed harm reduction programmes, with others such as Uganda, Mali and Mozambique following suit.86
Yet in other regions harm reduction continues to be rolled back, driven by support for increasingly harsh punitive approaches to people who use drugs. NSPs have been closed entirely in Bulgaria, Laos and the Philippines in recent years. If it continues, this worrying trend is likely to have a negative impact on a number of country's HIV epidemics.87
The influence of Russia, which explicitly takes an anti-harm reduction stance, is also being felt in a number of countries in Eastern Europe and Central Asia. This is despite the fact that injecting drug use is the main driver of HIV transmission in the region, the only in the world where HIV prevalence continues to rise, with new infections increasing by 30% between 2010 and 2017.88 Until political support for harm reduction increases, the HIV epidemic in the region, and elsewhere, is likely to continue.
Photo credit: Photo by Kaytee Riek/CC BY-NC-SA 2.0
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